ICD-10 F28
Billable / Specific HCC v28: 58Other psychotic disorder not due to a substance or known physiological condition
About ICD-10-CM F28
ICD-10-CM code F28 represents Other psychotic disorder not due to a substance or known physiological condition. This is a billable/specific code in the Mental, Behavioral, and Neurodevelopmental chapter (block F28). The 2026 edition of ICD-10-CM F28 became effective on October 1, 2025.
Coding Tips for F28
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
F28 is a CMS-HCC v28 risk-adjustment code (category 58). 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 F28. Per CMS ICD-10-CM Tabular 2026.
- Chronic hallucinatory psychosis
- Other specified schizophrenia spectrum and other psychotic disorder
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 F28
Local Coverage Determinations (LCDs) from CMS MACs that list F28 as a covered diagnosis.
Showing top 10 of 353 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing F28.
1 Cigna
5 Medicare
CPT Codes Commonly Billed with F28
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 F28 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 |
|---|---|---|
| F28 | 2989 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To F28
Other codes in section F20-F29 (Schizophrenia, schizotypal, delusional, and other non-mood psychotic disorders).
ICD-10 F28, Billing FAQ
Is ICD-10 code F28 billable? +
Yes, F28 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 F28? +
ICD-10 F28 includes: Chronic hallucinatory psychosis; Other specified schizophrenia spectrum and other psychotic disorder.
Does F28 affect Medicare Advantage HCC risk adjustment? +
Yes. F28 maps to CMS-HCC v28 category 58. Capture this diagnosis annually for accurate Medicare Advantage risk score.
What ICD-9 codes does F28 map to? +
Per CMS GEMs, F28 maps to ICD-9 codes: 2989. 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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