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. Look up the whole chart to see which of its HCCs the hierarchy would zero.

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 one applies depends on your Medicare contractor.

• 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