2026 ICD-10-CM Diagnosis Code F20.5Residual schizophrenia
ICD-10-CM Codes›F01–F99›F20-F29›F20
- Billable — Valid for Submission
- CC — Complication or Comorbidity
- Risk Adjusts — HCC 151
- Chronic Condition
F20.5 is a billable ICD-10-CM diagnosis code for residual schizophrenia. It is valid on HIPAA claims for fiscal year 2026 (October 1, 2025 through September 30, 2026) and groups to MS-DRG 885. As a secondary diagnosis, it counts as a complication or comorbidity (CC) and moves an inpatient stay to a higher severity level within its MS-DRG family. It does not count, however, when the principal diagnosis is one of 293 closely related codes. Coders also document this condition as chronic residual schizophrenia. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Schizophrenia spectrum and other psychotic disorders.
For Medicare Advantage risk adjustment, F20.5 maps to CMS-HCC Category 151 (Schizophrenia) under the V28 model, adding a risk factor of about 0.511 for a community, non-dual, aged beneficiary in payment year 2026.
Code Identity
Code Classification
Medicare Risk Adjustment (HCC)Billing
F20.5 maps to a payment category in the CMS-HCC model used to risk-adjust Medicare Advantage payments. Weights are the published community factors for payment year 2026.
Source: CMS Payment Year 2026 risk adjustment mappings and model software. Weights are relative factors, not dollar amounts; a beneficiary's total RAF also includes demographics and interactions. Browse all CMS-HCC categories.
Approximate SynonymsGuidance
Alternate terms and clinical phrases that map to this code.
- Chronic residual schizophrenia
- Chronic residual schizophrenia with acute exacerbations
- Residual schizophrenia
- Residual schizophrenia in remission
- Schizophrenia in remission
- Subchronic residual schizophrenia
- Subchronic residual schizophrenia with acute exacerbations
- Subchronic schizophrenia with acute exacerbations
Tabular List NotesGuidance
Coding notes and annotation back-references applicable to this code.
Inclusion Terms
- Restzustand (schizophrenic)
- Schizophrenic residual state
These terms are the conditions for which that code is to be used. The terms may be synonyms of the code title, or, in the case of "other specified" codes, the terms are a list of the various conditions assigned to that code. The inclusion terms are not necessarily exhaustive. Additional terms found only in the Alphabetic Index may also be assigned to a code.
Index to Diseases and InjuriesGuidance
Alphabetical index entries that point to this code.
Residual See Also: condition;
state, schizophrenic F20.5
Schizophrenia, schizophrenic F20.9
negative type F20.5
residual (state) (type) F20.5
restzustand F20.5
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Clinical InformationClinical
Schizophrenia
a severe emotional disorder of psychotic depth characteristically marked by a retreat from reality with delusion formation, hallucinations, emotional disharmony, and regressive behavior.Schizophrenia Spectrum and Other Psychotic Disorders
marked disorders of thought (delusions, hallucinations, or other thought disorder accompanied by disordered affect or behavior), and deterioration from a previous level of functioning. individuals have one o more of the following symptoms: delusions, hallucinations, and disorganized speech. (from dsm-5)Schizophrenia, Catatonic
a type of schizophrenia characterized by abnormality of motor behavior which may involve particular forms of stupor, rigidity, excitement or inappropriate posture.Schizophrenia, Childhood
an obsolete concept, historically used for childhood mental disorders thought to be a form of schizophrenia. it was in earlier versions of dsm but is now included within the broad concept of pervasive development disorders.Schizophrenia, Disorganized
a type of schizophrenia characterized by frequent incoherence; marked loosening of associations, or grossly disorganized behavior and flat or grossly inappropriate affect that does not meet the criteria for the catatonic type; associated features include extreme social withdrawal, grimacing, mannerisms, mirror gazing, inappropriate giggling, and other odd behavior. (dorland, 27th ed)Schizophrenia, Paranoid
a chronic form of schizophrenia characterized primarily by the presence of persecutory or grandiose delusions, often associated with hallucination.Schizophrenia, Treatment-Resistant
a subset of schizophrenia with an inadequate response in target symptoms following treatment with two or more antipsychotics.Schizotypal Personality Disorder
a personality disorder in which there are oddities of thought (magical thinking, paranoid ideation, suspiciousness), perception (illusions, depersonalization), speech (digressive, vague, overelaborate), and behavior (inappropriate affect in social interactions, frequently social isolation) that are not severe enough to characterize schizophrenia.Hallucinations
subjectively experienced sensations in the absence of an appropriate stimulus, but which are regarded by the individual as real. they may be of organic origin or associated with mental disorders.
Patient EducationClinical
Schizophrenia
Schizophrenia is a serious brain illness. People who have it may hear voices that aren't there. They may think other people are trying to hurt them. Sometimes they don't make sense when they talk. The disorder makes it hard for them to keep a job or take care of themselves.
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Convert F20.5 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About F20.5Overview
What is the ICD-10 code for residual schizophrenia?
The ICD-10-CM code for residual schizophrenia is F20.5 (sometimes written as F205). It is billable on HIPAA-covered claims from October 1, 2025 through September 30, 2026.
Is F20.5 (Schizophrenia) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report residual schizophrenia on HIPAA-covered claims from October 1, 2025 through September 30, 2026.
What MS-DRG does F20.5 group to?
When residual schizophrenia is the principal diagnosis on an inpatient stay, it groups to MS-DRG 885 (psychoses), which carries a relative weight of 1.3968. Higher weights mean higher Medicare reimbursement.
Is F20.5 a CC or MCC?
CMS lists F20.5 as a CC (complication or comorbidity) for FY 2026. Reported as a secondary diagnosis, it moves the inpatient stay to a higher-weighted DRG within its severity family. It does not count when the principal diagnosis is one of the 293 closely related codes in its exclusion list.
What is the ICD-9 equivalent of F20.5?
Under the General Equivalence Mappings, residual schizophrenia converts to ICD-9-CM 295.60 (schizophr dis resid NOS). The mapping is approximate, so confirm the match fits the documentation.
What HCC is F20.5?
F20.5 (residual schizophrenia) maps to CMS-HCC Category 151 (Schizophrenia), commonly written as HCC 151, in the CMS-HCC V28 model used for Medicare Advantage risk adjustment in payment year 2026. It mapped to HCC 57 under the retired V24 model. It also maps in the PACE (CMS-HCC V22), ESRD (V21), and ESRD (V24) models. In the Part D prescription drug model it maps to RxHCC 130.
Does F20.5 risk-adjust for Medicare Advantage payment?
Yes. When documented and reported on a Medicare Advantage encounter, F20.5 adds a risk adjustment factor of about 0.511 to the beneficiary's RAF score for a community, non-dual, aged enrollee (published V28 weights range from 0.304 to 0.591 depending on the payment segment). HCC 151 sits at the top of its hierarchy, so no other condition category supersedes it. See the full factor table on the HCC 151 category page.
