F33.2 at a glance
F33.2 | |
|---|---|
Official description | Major depressive disorder, recurrent severe without psychotic features |
Billable | Yes, valid in the FY2027 ICD-10-CM release |
Category | F33, Major depressive disorder, recurrent |
Block | F30-F39, Mood [affective] disorders |
Includes (category F33) | Recurrent episodes of major depression, of reactive or psychogenic depression, and of seasonal affective disorder, among others |
Excludes1 (category F33) | Bipolar disorder (F31.-), manic episode (F30.-) |
The official description really does read "recurrent severe" with no comma, unlike F33.1 ("recurrent, moderate") and F33.3 ("recurrent, severe with psychotic symptoms"). F33.3 also says "symptoms" where F33.2 says "features". Neither difference changes the meaning.
F33.2 vs F33.1, F33.3 and F32.2
Two questions decide the code: has the client had an earlier major depressive episode, and how severe is the current one, with or without psychotic features. The index entry is "Disorder, depressive, recurrent, current episode, severe (without psychotic symptoms)", and it leads to F33.2.
Course and current episode | Code |
|---|---|
Recurrent, current episode severe, no psychotic features | F33.2 |
Recurrent, current episode severe, with psychotic features | F33.3 |
Recurrent, current episode moderate | F33.1 |
Recurrent, current episode mild | F33.0 |
Recurrent, in partial remission | F33.41 |
Recurrent, in full remission | F33.42 |
Recurrent, severity not documented | F33.9 |
First episode, severe, no psychotic features | F32.2 |
Related depression codes: F33.0, F33.1, F32.1, F32.9, F32.A and F34.1.
Seasonal depression and F33.2
Category F33 includes recurrent episodes of seasonal affective disorder, and the index sends "Depression, seasonal" to the recurrent depressive disorder entries. So a client with a seasonal pattern whose winter episode is severe, with no psychotic features, is coded F33.2. The index has no separate code for the seasonal pattern, so describe it in the note.
When F33.2 is the right code
Use F33.2 when the record shows at least one earlier major depressive episode and the clinician rates the current episode as severe, with hallucinations and delusions asked about and absent. All three need to be in the notes. A PHQ‑9 total supports the severity rating, but the rating itself is a clinical judgment and should be written as one.
A history of mania or hypomania rules F33.2 out. Category F33 has an Excludes1 note for bipolar disorder (F31.‑) and manic episode (F30.‑), so those conditions and recurrent major depression aren't coded together.
What to document for a severe episode
- The earlier episode or episodes: roughly when, how long, and how they were treated.
- Why you rate this episode severe: the symptoms present and how much they impair work, self-care or relationships.
- Psychotic symptoms screened for and not present.
- A risk assessment at every session while the episode is severe, with any safety plan updated.
- Medication, other treatment and coordination with the prescriber.
Example, fictional client. 52‑year‑old high school teacher, third depressive episode (first at 31, second at 44, both treated with sertraline and therapy). On leave from work for three weeks; eating once a day, in bed until early afternoon. PHQ‑9 today: 23. Passive wish not to wake up, no plan or intent; safety plan reviewed and updated with her husband's number added. No hallucinations or delusions. Diagnosis: major depressive disorder, recurrent, severe without psychotic features (F33.2). Plan: weekly sessions, psychiatry follow‑up moved up to this week.
Our mental health risk assessment template and safety plan template cover the safety part of that note.
Billing F33.2
CPT code | Common use with F33.2 |
|---|---|
90791 | Diagnostic evaluation |
90837 | A 60-minute psychotherapy session |
99214 with 90833 | A psychiatric medication visit with psychotherapy added on |
90839, 90840 | Psychotherapy for crisis, when a session is spent on acute risk |
96127 | A scored PHQ-9 or similar brief measure |
See 90791, 90837, 90833, 90839 and 96127. TMS (90867, 90868) and ECT (90870) have their own codes, and each payer sets its own criteria for them, so check the policy before the first treatment.
CPT is a registered trademark of the American Medical Association. CPT codes copyright 2026 American Medical Association. All rights reserved.
Common mistakes with F33.2
- Using F33.2 for a first episode. With no earlier episode on record, a severe episode is F32.2.
- Keeping F33.2 on every claim after the client improves. Moderate is F33.1; partial remission is F33.41.
- Writing "severe" with nothing behind it. Describe the symptoms and the impairment that make it severe.
- Skipping the psychosis screen. If psychotic features are present, the code is F33.3.
- Missing a bipolar history. The Excludes1 note rules out F33 codes when bipolar disorder is diagnosed.
If you dictate or record sessions, an AI therapy notes tool can draft the risk assessment and diagnosis lines for you to review. The severity rating stays yours.
Checked against the FY2027 ICD‑10‑CM code set from CMS on October 12, 2026. Category F33 had no additions, deletions or description changes this year.