F20.9: Schizophrenia, unspecified
F20.9 is a billable, specific ICD-10-CM code for schizophrenia, unspecified. It is valid for submission on a claim.
Check F20.9 with the rest of the claim: free scrubberExcludes1 inherited from the categories above F20.9
A category’s note binds every code beneath it.
Excludes2 inherited from the categories above F20.9
Not part of this code, but both may be coded when both are present.
Other codes that can never be billed with F20.9
Their own Excludes1 notes name this code, so the conflict is not listed above.
- F25Schizoaffective disorders
Risk adjustment
F20.9 risk-adjusts. Under the CMS-HCC V28 model it maps to these categories:
- HCC 151 Schizophrenia0.511 RAF
- HCC 151 Schizophrenia0.511 RAF
Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score. Look up the whole chart to see which of its HCCs the hierarchy would zero.
Medicare coverage
F20.9 is named in 11 Medicare coverage policies: 10 listing it as supporting medical necessity, and 1 listing it as NOT covered. Which one applies depends on your Medicare contractor.
- A52434Health and Behavior Assessment/Intervention – Medical Policy Articlenot covered
- A56614Billing and Coding: Psychiatric Inpatient Hospitalization
- A56645Billing and Coding: Controlled Substance Monitoring and Drugs of Abuse Testing
- A56818Billing and Coding: Urine Drug Testing
Alphabetic index entries that lead here
- Schizophrenia, schizophrenic
- Schizophrenia, schizophrenic›childhood type
- Schizophrenia, schizophrenic›chronic undifferentiated
- Syndrome›schizophrenic, of childhood NEC
- Schizophrenia, schizophrenic›undifferentiated›chronic
Code history
Unchanged in every release from FY2024 to FY2027.