F33.2: Major depressive disorder, recurrent severe without psychotic features

The ICD-10-CM code for major depressive disorder when the provider documents at least two discrete depressive episodes and a current episode that is severe without psychotic features.

Billable

FY2027

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At a glance

Code Family

F33: Major depressive disorder, recurrent, in block F30–F39, Mood (affective) disorders, chapter 5.

DRG Grouping

With F33.2 as the principal inpatient diagnosis the admission groups to MS-DRG 885, Psychoses, in MDC 19 under the FY2027 MS-DRG v44 grouper. That MS-DRG is a single DRG with no CC or MCC split.

HCC Mapping (v28)

HCC 155: Major Depression, Moderate or Severe, without Psychosis.

Condition

Major depressive disorder

Family Specificity

Nine codes in the F33 family running along a severity axis: mild, moderate, severe without psychotic features and severe with psychotic features, plus three remission codes and an unspecified code.

Which depression code do I assign?

The F33 family is structured along two axes: the severity of the current episode and the presence or absence of psychotic features, with a separate sub-family for remission states. Both recurrence and severity are provider-documented findings, not coder inferences. The code follows the language in the note rather than any score or impression.

When documentation says…

Code

Two or more separate depressive episodes with remission between them, and a current episode documented as severe with no psychotic features

F33.2

Use when the note documents recurrence, states that the current episode is severe, and either states without psychotic features or supports that absence clearly. All three elements must come from the provider.

Recurrent depression, current episode severe, with documented delusions or hallucinations

F33.3

Psychotic features make F33.3 the only correct choice. F33.2 and F33.3 are mutually exclusive for any given episode.

Recurrent depression with the current episode documented as moderate

F33.1

Use when the provider documents moderate severity. F33.1 also maps to HCC 155.

Recurrent depression with the current episode documented as mild

F33.0

Mild recurrent depression was removed from the CMS-HCC v28 model and carries no HCC credit.

A first documented major depressive episode that is severe without psychotic features

F32.2

Recurrence requires two or more separate episodes with a period of remission between them. A first episode is the single-episode code. F32.2 also maps to HCC 155.

Recurrent depression documented as being in remission

F33.41 Major depressive disorder, recurrent, in partial remission, with F33.42 for full remission and F33.40 where the remission state is not specified. None of the three carries HCC credit under v28.

A recurrent depressive disorder that has no dedicated code elsewhere in the family

F33.8

Other recurrent depressive disorders.

Bipolar depression, or the depressive phase of bipolar disorder

F31.-

The F33 category carries an Excludes1 note for bipolar disorder. Select the appropriate F31.x code based on the episode type documented and do not report F33.2.

Recurrent major depression documented with no severity qualifier

F33.9

The residual code. It does not generate HCC 155 credit under v28. Query the provider when the severity of the current episode is not stated rather than defaulting here.

Tabular notes

EXCLUDES1 AT THE F33 CATEGORY LEVEL

Bipolar disorder (F31.-) and manic episode (F30.-) are both Type 1 excludes at the F33 category level. A diagnosis of bipolar disorder or of a manic episode is not coded with F33.2 for the same condition. Only the appropriate F31.x or F30.x code applies.

PARENT-LEVEL INHERITANCE

Both Excludes1 notes sit at the F33 category level and are inherited by every F33.x subcode, including F33.2. No additional Excludes notes appear at the F33.2 code level.

NO CODE FIRST, USE ADDITIONAL OR EXCLUDES2

F33.2 carries no Code Also, Code First, Use Additional or Excludes2 instruction in the FY2027 tabular. Comorbid anxiety or substance use disorders may be reported in addition to F33.2 when they are independently documented as separate conditions rather than as manifestations of the depressive episode.

FY2027 CHANGES

No structural changes to F33.2. The FY2027 codes and tabular addenda add, delete or revise no code or note in category F33. F33.2 is unchanged in the FY2027 update.

Operational & financial impact

Why specificity matters beyond the chart: risk adjustment, DRG assignment and denial exposure all follow from which code is selected.

CMS-HCC v28 (PY2024+)

HCC 155: Major Depression, Moderate or Severe, without Psychosis. F33.2 maps to this category under CMS-HCC v28, which is 100 percent operative for payment year 2026. Within categories F32 and F33, the codes that map to HCC 155 are F32.1, F32.2, F33.1 and F33.2.

V24 TO V28 TRANSITION

Under v24, F33.2 mapped to HCC 59, Major Depressive, Bipolar, and Paranoid Disorders. The v28 model split and narrowed that category: only moderate depression and severe depression without psychosis map to HCC 155, while mild, unspecified and remission codes lost HCC status altogether. Bipolar disorder codes that previously co-mapped under HCC 59 now route to separate v28 categories.

HCC RECAPTURE

For Medicare Advantage plans, F33.2 must be documented as an active, assessed condition at a qualifying face-to-face encounter within the measurement year to generate HCC 155 credit. The encounter must include active assessment and management of the depression. A historical mention on a problem list without current management does not satisfy the requirement.

MEDICARE AND PAYER COVERAGE

F33.2 is covered under Medicare Part A and Part B for qualifying psychiatric and medical encounters. Outpatient psychiatric visits, psychotherapy and psychiatric evaluation and management may be billed under F33.2 when it is the diagnosis driving the service. Traditional Medicare Fee-for-Service uses diagnosis data for quality and efficiency measurement rather than premium setting.

WHERE SPECIFICITY IS LOST

A note reading only major depression, recurrent, with no severity qualifier defaults to F33.9, which generates no HCC 155 credit under v28. Other errors include coding F33.2 for a first episode that belongs on F32.2, using it when psychotic features are documented, and failing to add F33.2 as an additional diagnosis on medical encounters where the depression is actively managed.

Documentation checklist to support F33.2

Chart elements that support code selection and reduce specificity-driven denials.

Provider documentation that the patient has had prior episodes of major depression, such as recurrent major depressive disorder or a history of previous depressive episodes.

An explicit provider statement that the current episode is severe, such as severe depression or major depressive episode, severe, or documentation consistent with marked functional impairment.

Documentation of significant functional impairment affecting work, social relationships or self-care to support the severe designation.

An explicit statement that psychotic features are absent, or documentation from which their absence can be clearly inferred.

Confirmation that the diagnosis is not bipolar disorder or a manic episode, both of which are Excludes1 at the F33 category level.

Evidence that the condition was actively assessed and managed at a qualifying face-to-face encounter within the measurement year when HCC 155 capture is intended.

A compliant provider query when the record documents recurrent major depressive disorder without stating the severity of the current episode, asking the provider to clarify whether the episode is mild, moderate, severe without psychotic features or severe with psychotic features.

FAQ

When is F33.2 correct instead of F33.9?

F33.2 requires the provider to document that the current episode is severe. F33.9, major depressive disorder recurrent unspecified, is used when severity is not documented. Under CMS-HCC v28 only F33.1 and F33.2 generate HCC 155 credit. Documenting severity is essential for accurate risk adjustment.

Does a PHQ-9 score replace the provider's severity statement?

No. Validated depression rating scales support severity documentation in the clinical note but do not substitute for the provider's explicit clinical severity statement. The coder needs an explicit designation of mild, moderate or severe in the provider's own note, and instrument scores are not required for coding purposes.

Can F33.2 be reported together with a bipolar disorder code?

F33.2 and a bipolar disorder code are not reported together for the same condition. The F33 category carries a Type 1 Excludes1 note for bipolar disorder, F31.-, which is inherited by F33.2. When bipolar disorder is the diagnosis only the appropriate F31.x code is reported. The same applies to the F30.- codes for manic episode.

What is the difference between F33.2 and F33.3?

Both describe a recurrent severe major depressive episode. F33.2 is used when psychotic features are absent or not documented, and F33.3 is used when delusions, hallucinations or other psychotic symptoms are present and documented.

When does a severe episode map to F32.2 rather than F33.2?

F33.2 requires at least two episodes. If the current severe episode is the patient's first documented major depressive episode, the correct code is F32.2, major depressive disorder single episode severe without psychotic features. Recurrence means two or more separate episodes with a period of remission between them.

What changed for F33.2 under CMS-HCC v28?

Under v24, F33.2 mapped to HCC 59, Major Depressive, Bipolar, and Paranoid Disorders. Under v28 it maps to HCC 155, Major Depression, Moderate or Severe, without Psychosis, a narrower and more specific category. Mild, unspecified and remission MDD codes lost HCC status in the transition.

Can F33.2 be reported on a medical encounter that is not psychiatric?

Yes. When F33.2 is present as a comorbidity during a medical encounter and meets the definition of affecting the management of the encounter, it may be coded as an additional diagnosis. Sequence it after the primary reason for the encounter.

How are uncertain diagnoses handled in the inpatient and outpatient settings?

In the inpatient setting, a diagnosis documented as probable or likely at discharge may be coded as confirmed under the UHDDS guidelines in Section II.H of the FY2027 Official Guidelines. In the outpatient setting, do not code conditions documented as rule-out, possible or suspected. Code the presenting sign or symptom instead. On inpatient psychiatric admissions, assign the F33.x code supported by the final discharge documentation rather than the working admitting diagnosis.

Related codes

Codes in the same family as F33.2. Only codes with a published page render as links.

Sibling codes in the F33 family

F33.0: Major depressive disorder, recurrent, mild.
F33.1: Major depressive disorder, recurrent, moderate.
F33.2: Major depressive disorder, recurrent severe without psychotic features.
F33.3: Major depressive disorder, recurrent, severe with psychotic symptoms.
F33.40: Major depressive disorder, recurrent, in remission, unspecified.
F33.41: Major depressive disorder, recurrent, in partial remission.
F33.42: Major depressive disorder, recurrent, in full remission.
F33.8: Other recurrent depressive disorders.
F33.9: Major depressive disorder, recurrent, unspecified.

Additional codes to consider

Codes outside the F33 family considered alongside F33.2.

Companion: code alongside when documented

F33.2 carries no Code Also, Code First or Use Additional instruction. Comorbid conditions such as anxiety disorders and substance use disorders may be reported in addition to F33.2. They must be independently documented and treated as separate conditions rather than as manifestations of the depressive episode.

Consider instead

F32.2: Major depressive disorder, single episode, severe without psychotic features, the first-episode equivalent, which also maps to HCC 155.
F33.1: Major depressive disorder, recurrent, moderate, when the provider documents moderate severity. Also maps to HCC 155.
F33.3: Major depressive disorder, recurrent, severe with psychotic symptoms, when psychosis is documented.
F33.9: Major depressive disorder, recurrent, unspecified, only when severity is not documented. No HCC credit under v28.
F32.9: Major depressive disorder, single episode, unspecified. No HCC credit under v28.
F31-: Bipolar disorder, an Excludes1 at the F33 category level, when bipolar disorder is the diagnosis.
F33.40: Major depressive disorder, recurrent, in remission, unspecified. No HCC credit.
F33.41: Major depressive disorder, recurrent, in partial remission. No HCC credit.
F33.42: Major depressive disorder, recurrent, in full remission. No HCC credit.
Z86.59: Personal history of other mental and behavioral disorders, which may be used after resolution.

Sources

All claims on this page derive from government and professional-standards sources.

National Center for Health Statistics. (2026). International classification of diseases, tenth revision, clinical modification (ICD-10-CM) FY2027 files. https://www.cdc.gov/nchs/icd/icd-10-cm/files.html
Centers for Medicare & Medicaid Services and National Center for Health Statistics. (2026). ICD-10-CM official guidelines for coding and reporting FY2027. https://ftp.cdc.gov/pub/Health_Statistics/NCHS/Publications/ICD10CM/2027/ICD-10-CM-October-1-2026-FY27-Guidelines.pdf
Centers for Medicare & Medicaid Services. (2025). 2026 model software/ICD-10 mappings. https://www.cms.gov/medicare/payment/medicare-advantage-rates-statistics/risk-adjustment/2026-model-software-icd-10-mappings
Centers for Medicare & Medicaid Services. (2026). MS-DRG classifications and software, version 44. https://www.cms.gov/medicare/payment/prospective-payment-systems/acute-inpatient-pps/ms-drg-classifications-and-software