ICD-10 F33: Recurrent Major Depressive Disorder — Billing Guide
F33.0, F33.1, F33.2, and F33.9 explained — how recurrent MDD (F33) differs from a single episode (F32), severity specifiers, and which CPT codes to pair with it.
2026-03-28 · 5 min read · By The Superbilled Team
ICD-10 F33 codes cover Recurrent Major Depressive Disorder — a distinct classification from F32 (single episode) that signals the client has had two or more separate depressive episodes. Selecting the right F33 subcode, and understanding when to use F33 vs F32, directly affects how claims are reviewed for medical necessity.
What Does ICD-10 F33 Mean?
F33 maps to the DSM-5 diagnosis of Major Depressive Disorder, Recurrent Episode. To support an F33 code, the clinical record must demonstrate that the client has experienced at least two distinct major depressive episodes — separated by a period of at least two consecutive months in which full MDD criteria were not met. This is the primary differentiator from F32 (single episode).
Clinically, recurrent MDD carries a higher risk of future episodes, is often associated with a more chronic course, and may require more intensive or longer-term treatment. Insurers recognize this — recurrent codes are generally well-accepted and less likely to trigger medical necessity reviews than unspecified codes.
F33 Subcodes
| Code | Description |
|---|---|
| F33.0 | Recurrent major depressive disorder, current episode mild. PHQ-9 score roughly 5–9; minimal functional impairment. |
| F33.1 | Recurrent major depressive disorder, current episode moderate. PHQ-9 score roughly 10–14; moderate functional impairment. |
| F33.2 | Recurrent major depressive disorder, current episode severe without psychotic features. PHQ-9 ≥ 15; significant impairment in work, relationships, or self-care. |
| F33.3 | Recurrent major depressive disorder, current episode severe with psychotic features. Requires documentation of mood-congruent or mood-incongruent psychotic symptoms. |
| F33.40 | Recurrent major depressive disorder, currently in remission, unspecified. |
| F33.41 | Recurrent major depressive disorder, in partial remission. |
| F33.42 | Recurrent major depressive disorder, in full remission. |
| F33.9 | Recurrent major depressive disorder, unspecified. Use sparingly; severity should be specified whenever the clinical picture is clear. |
F33 vs F32: When to Use Which
- Use F32.x when the client presents with their first known major depressive episode and there is no documented history of a prior episode. See the full guide to F32 single-episode MDD codes.
- Use F33.xwhen the clinical or personal history clearly documents a prior depressive episode — either from the client's self-report, prior treatment records, or your own prior treatment of this client.
- If history is unclear at intake, F32.9 (unspecified single episode) is acceptable initially. Update to F33.x once episode history is established.
- Switching from F32 to F33 mid-treatment is clinically appropriate and expected — this represents a diagnostic refinement, not an error.
How to Bill ICD-10 F33 on a Superbill
F33.x codes pair directly with outpatient psychotherapy CPT codes. The code alone does not require any special modifiers or prior authorization for most commercial plans, though high-severity presentations (F33.2, F33.3) may trigger utilization management review at some payers.
Place the F33 subcode in the primary diagnosis field on the superbill. If the client also carries a comorbid diagnosis (e.g., F41.1 for comorbid GAD), list the primary treatment focus first and the secondary diagnosis on the next diagnosis line.
CPT Codes Commonly Paired With F33
- 90837 — 60-minute individual psychotherapy. The most common pairing for moderate-to-severe recurrent depression, where longer sessions are often clinically necessary.
- 90834 — 45-minute individual psychotherapy. Appropriate for maintenance-phase treatment or milder presentations.
- 90832 — 30-minute individual psychotherapy. Less common for recurrent MDD treatment; use when sessions are genuinely brief.
- 90791 — Psychiatric diagnostic evaluation. Use for the initial intake session when a full diagnostic assessment is conducted.
- 90847 — Family therapy with client present. Consider when family dynamics are a key component of the treatment plan for recurrent depression.
Documentation Requirements
- Documentation of prior major depressive episode(s) — from history, prior provider records, or client self-report with approximate dates
- Current episode onset date and duration
- DSM-5 symptom count (5 of 9 criteria met, including depressed mood or anhedonia)
- Severity assessment — PHQ-9 score or equivalent functional impairment narrative
- Specifiers if applicable: anxious distress, melancholic features, peripartum onset, seasonal pattern
- Treatment plan with frequency and modality justified by the severity level
Common Denial Reasons
- Missing episode history: The claim uses F33 but the record contains no documentation of a prior episode. Use F32 or document the history explicitly.
- Severity mismatch: F33.2 is billed but notes only describe mild impairment. Ensure PHQ-9 scores and functional narrative match the severity subcode.
- F33.9 overuse: Repeated claims with unspecified severity can trigger a medical necessity review request. Specify severity whenever possible.
- Remission codes without treatment rationale: Billing F33.41 or F33.42 without documenting the reason continued treatment is clinically warranted (e.g., relapse prevention) may result in a medical necessity denial.
Generate a Superbill With F33
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