F94.0 ICD-10-CM Code: Selective mutism
HCC Buddy Code Card
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FY 2026 Apr update / Mental, Behavioral and Neurodevelopmental disorders (F01-F99) / Behavioral and emotional disorders with onset usually occurring in childhood and adolescence (F90-F98)
F94.0
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceSelective mutism
A condition where a child is able to speak but chooses not to speak in certain social situations, such as school, despite speaking normally in other settings like home.
CMS-HCC V28
00
RAF 0
CMS-HCC V24
00
RAF 0
ACA/HHS
00
RAF 0
ESRD/PACE
00
RAF 0
RXHCC
00
RAF 0
Code Trumping
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Code Book Path
Inclusion Terms
Official- Elective mutism
Excludes 2
Official- pervasive developmental disorders (F84.-)
- schizophrenia (F20.-)
- specific developmental disorders of speech and language (F80.-)
- transient mutism as part of separation anxiety in young children (F93.0)
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for F94.0 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for F94.0 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for F94.0 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for F94.0 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for F94.0 in this effective period.
Buddy Documentation Tip
Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.
Is F94.0 an HCC code?
No. F94.0 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
Coder workflow notes
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This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
F94.0 is the ICD-10-CM diagnosis code for selective mutism. A condition where a child is able to speak but chooses not to speak in certain social situations, such as school, despite speaking normally in other settings like home. F94.0 sits in the ICD-10-CM chapter for mental, behavioral and neurodevelopmental disorders (f01-f99), within the section covering behavioral and emotional disorders with onset usually occurring in childhood and adolescence (f90-f98).
F94.0 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.
Document the specific situations where the child fails to speak and confirm normal speech ability in other contexts.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for F94.0 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document the specific situations where the child fails to speak and confirm normal speech ability in other contexts
- •Ensure onset is in childhood and that the condition persists for at least one month