ICD-10 F20.3
Billable / Specific HCC v28: 57Undifferentiated schizophrenia
About ICD-10-CM F20.3
ICD-10-CM code F20.3 represents Undifferentiated schizophrenia. This is a billable/specific code in the Mental, Behavioral, and Neurodevelopmental chapter (block F20). The 2026 edition of ICD-10-CM F20.3 became effective on October 1, 2025.
Coding Tips for F20.3
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
F20.3 is a CMS-HCC v28 risk-adjustment code (category 57). 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 F20.3. Per CMS ICD-10-CM Tabular 2026.
- Atypical schizophrenia
Type 1 Excludes
Pure excludes, these codes can never be coded together with F20.3. The conditions are mutually exclusive (e.g., congenital vs acquired forms).
- acute schizophrenia-like psychotic disorder (F23)
Type 2 Excludes
Not included here, the excluded code is not part of F20.3, but a patient may have both conditions at the same time. Both codes may be coded together when applicable.
- post-schizophrenic depression (F32.89)
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 F20.3
Local Coverage Determinations (LCDs) from CMS MACs that list F20.3 as a covered diagnosis.
Showing top 10 of 613 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing F20.3.
5 Medicare
CPT Codes Commonly Billed with F20.3
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- 0034U CMS LCD: Billing and Coding: MolDX: Pharmacogenomics Testing CMS LCD
- 0074U CMS LCD: Billing and Coding: MolDX: Pharmacogenomics Testing CMS LCD
- 81232 CMS LCD: Billing and Coding: MolDX: Pharmacogenomics Testing CMS LCD
- 81401 CMS LCD: Billing and Coding: MolDX: Pharmacogenomics Testing CMS LCD
- 0030U CMS LCD: Billing and Coding: MolDX: Pharmacogenomics Testing CMS LCD
- 81350 CMS LCD: Billing and Coding: MolDX: Pharmacogenomics Testing CMS LCD
- 0071U CMS LCD: Billing and Coding: MolDX: Pharmacogenomics Testing CMS LCD
- 81406 CMS LCD: Billing and Coding: MolDX: Pharmacogenomics Testing CMS LCD
- 0076U CMS LCD: Billing and Coding: MolDX: Pharmacogenomics Testing CMS LCD
- 81328 CMS LCD: Billing and Coding: MolDX: Pharmacogenomics Testing CMS LCD
Convert F20.3 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 |
|---|---|---|
| F20.3 | 29590 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To F20.3
Other codes in section F20-F29 (Schizophrenia, schizotypal, delusional, and other non-mood psychotic disorders).
ICD-10 F20.3, Billing FAQ
Is ICD-10 code F20.3 billable? +
Yes, F20.3 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 F20.3? +
ICD-10 F20.3 includes: Atypical schizophrenia.
What codes are Type 1 Excludes for F20.3? +
Type 1 Excludes (never code together with F20.3): acute schizophrenia-like psychotic disorder (F23)
What codes are Type 2 Excludes for F20.3? +
Type 2 Excludes (may be coded together when both conditions exist): post-schizophrenic depression (F32.89)
Does F20.3 affect Medicare Advantage HCC risk adjustment? +
Yes. F20.3 maps to CMS-HCC v28 category 57. Capture this diagnosis annually for accurate Medicare Advantage risk score.
What CPT codes are commonly billed with F20.3? +
Procedures frequently paired with F20.3 include: 0034U, 0074U, 81232, 81401, 0030U.
What ICD-9 codes does F20.3 map to? +
Per CMS GEMs, F20.3 maps to ICD-9 codes: 29590. 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 June 3, 2026.
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