ICD-10 F04
Billable / Specific HCC v28: 52Amnestic disorder due to known physiological condition
About ICD-10-CM F04
ICD-10-CM code F04 represents Amnestic disorder due to known physiological condition. This is a billable/specific code in the Mental, Behavioral, and Neurodevelopmental chapter (block F04). The 2026 edition of ICD-10-CM F04 became effective on October 1, 2025.
Coding Tips for F04
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
F04 is a CMS-HCC v28 risk-adjustment code (category 52). To count for the patient Risk Adjustment Factor (RAF), document the diagnosis with MEAT language each calendar year: Monitored, Evaluated, Assessed, Treated. A diagnosis on the problem list alone does not satisfy CMS RADV audit standards. Include the diagnosis in the assessment with current status and current treatment plan.
Inclusion Terms / Approximate Synonyms
Clinical terms and conditions classified under F04. Per CMS ICD-10-CM Tabular 2026.
- Korsakov's psychosis or syndrome, nonalcoholic
Type 1 Excludes
Pure excludes, these codes can never be coded together with F04. The conditions are mutually exclusive (e.g., congenital vs acquired forms).
- amnesia NOS (R41.3)
- anterograde amnesia (R41.1)
- dissociative amnesia (F44.0)
- retrograde amnesia (R41.2)
Type 2 Excludes
Not included here, the excluded code is not part of F04, but a patient may have both conditions at the same time. Both codes may be coded together when applicable.
- alcohol-induced or unspecified Korsakov's syndrome (F10.26, F10.96)
- Korsakov's syndrome induced by other psychoactive substances (F13.26, F13.96, F19.16, F19.26, F19.96)
Coding Notes
Code First
- the underlying physiological condition
Medicare Advantage HCC Impact
Capture this diagnosis annually for accurate risk adjustment. Missed HCC captures are the #1 revenue leak in Medicare Advantage risk programs.
Medicare LCD Coverage for F04
Local Coverage Determinations (LCDs) from CMS MACs that list F04 as a covered diagnosis.
Showing top 10 of 248 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing F04.
1 Cigna
5 Medicare
CPT Codes Commonly Billed with F04
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- G0156 CMS LCD: Billing and Coding: Home Health - Psychiatric Care CMS LCD
- G0299 CMS LCD: Billing and Coding: Home Health - Psychiatric Care CMS LCD
- G0152 CMS LCD: Billing and Coding: Home Health - Psychiatric Care CMS LCD
- G0155 CMS LCD: Billing and Coding: Home Health - Psychiatric Care CMS LCD
- G0300 CMS LCD: Billing and Coding: Home Health - Psychiatric Care CMS LCD
- G0323 CMS LCD: Billing and Coding: Outpatient Psychotherapy CMS LCD
- G0570 CMS LCD: Billing and Coding: Outpatient Psychotherapy CMS LCD
- G0409 CMS LCD: Billing and Coding: Outpatient Psychotherapy CMS LCD
Convert F04 to ICD-9-CM
Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.
| ICD-10 | ICD-9 | Mapping Flags |
|---|---|---|
| F04 | 2940 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To F04
Other codes in section F01-F09 (Mental disorders due to known physiological conditions).
ICD-10 F04, Billing FAQ
Is ICD-10 code F04 billable? +
Yes, F04 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
What other names or terms map to F04? +
ICD-10 F04 includes: Korsakov's psychosis or syndrome, nonalcoholic.
What codes are Type 1 Excludes for F04? +
Type 1 Excludes (never code together with F04): amnesia NOS (R41.3); anterograde amnesia (R41.1); dissociative amnesia (F44.0)
What codes are Type 2 Excludes for F04? +
Type 2 Excludes (may be coded together when both conditions exist): alcohol-induced or unspecified Korsakov's syndrome (F10.26, F10.96); Korsakov's syndrome induced by other psychoactive substances (F13.26, F13.96, F19.16, F19.26, F19.96)
Does F04 affect Medicare Advantage HCC risk adjustment? +
Yes. F04 maps to CMS-HCC v28 category 52. Capture this diagnosis annually for accurate Medicare Advantage risk score.
What CPT codes are commonly billed with F04? +
Procedures frequently paired with F04 include: G0156, G0299, G0152, G0155, G0300.
What ICD-9 codes does F04 map to? +
Per CMS GEMs, F04 maps to ICD-9 codes: 2940. Useful for legacy data review and historical claim analysis.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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