F28 — Other psychotic disorder not due to a substance or known physiological condition

Risk adjustment

F28 risk-adjusts. Under the CMS-HCC V28 model it maps to these categories:

• HCC 152 Psychosis, Except Schizophrenia0.484 RAF
• HCC 152 Psychosis, Except Schizophrenia0.484 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.

Medicare coverage

F28 is named in 20 Medicare coverage policies — 19 listing it as supporting medical necessity, and 1 listing it as NOT covered. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.

• A52434Health and Behavior Assessment/Intervention – Medical Policy Articlenot covered
• A56612Billing and Coding: CT of the Head
• A56614Billing and Coding: Psychiatric Inpatient Hospitalization
• A56645Billing and Coding: Controlled Substance Monitoring and Drugs of Abuse Testing