ICD-10 F21
Billable / Specific HCC v28: 60Schizotypal disorder
About ICD-10-CM F21
ICD-10-CM code F21 represents Schizotypal disorder. This is a billable/specific code in the Mental, Behavioral, and Neurodevelopmental chapter (block F21). The 2026 edition of ICD-10-CM F21 became effective on October 1, 2025.
Coding Tips for F21
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
F21 is a CMS-HCC v28 risk-adjustment code (category 60). 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 F21. Per CMS ICD-10-CM Tabular 2026.
- Borderline schizophrenia
- Latent schizophrenia
- Latent schizophrenic reaction
- Prepsychotic schizophrenia
- Prodromal schizophrenia
- Pseudoneurotic schizophrenia
- Pseudopsychopathic schizophrenia
- Schizotypal personality disorder
Type 2 Excludes
Not included here, the excluded code is not part of F21, but a patient may have both conditions at the same time. Both codes may be coded together when applicable.
- Asperger's syndrome (F84.5)
- schizoid personality disorder (F60.1)
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 F21
Local Coverage Determinations (LCDs) from CMS MACs that list F21 as a covered diagnosis.
Showing top 10 of 168 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing F21.
1 Cigna
5 Medicare
CPT Codes Commonly Billed with F21
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
We don't have CPT pairings indexed for this specific code yet. Use the CPT search above to find common procedures, or check your payer's published medical policy for code-specific guidance.
Convert F21 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 |
|---|---|---|
| F21 | 30122 | 00000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To F21
Other codes in section F20-F29 (Schizophrenia, schizotypal, delusional, and other non-mood psychotic disorders).
ICD-10 F21, Billing FAQ
Is ICD-10 code F21 billable? +
Yes, F21 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 F21? +
ICD-10 F21 includes: Borderline schizophrenia; Latent schizophrenia; Latent schizophrenic reaction, and 5 more clinical synonyms.
What codes are Type 2 Excludes for F21? +
Type 2 Excludes (may be coded together when both conditions exist): Asperger's syndrome (F84.5); schizoid personality disorder (F60.1)
Does F21 affect Medicare Advantage HCC risk adjustment? +
Yes. F21 maps to CMS-HCC v28 category 60. Capture this diagnosis annually for accurate Medicare Advantage risk score.
What ICD-9 codes does F21 map to? +
Per CMS GEMs, F21 maps to ICD-9 codes: 30122. 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 1, 2026.
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