F25.8: Other schizoaffective disorders

Risk adjustment

F25.8 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

F25.8 is named in 18 Medicare coverage policies: 17 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
• A56685Billing and Coding: Partial Hospitalization Programs