F33.1 ICD-10 code: Recurrent major depressive disorder
F33.1, the ICD-10 code refers to Major Depressive Disorder, recurrent, moderate, a commonly used diagnosis in outpatient mental health. Oftentimes, mental health diagnosis codes often feel like administrative necessities rather than clinical tools.
However, ICD-10 codes play a significant role in how treatment is documented, reimbursed, and understood across systems of care.
Summary
- F33.1 reflects moderate, recurrent depression and requires documentation of both prior depressive episodes and current functional impairment to support accurate diagnosis and reimbursement.
- Moderate severity is defined by meaningful but not extreme impairment, where clients can often maintain responsibilities but with significant distress, fatigue, or reduced functioning.
- Treatment typically combines psychotherapy and, when appropriate, medication, with strong emphasis on relapse prevention and ongoing symptom monitoring. Download my free relapse prevention plan template.
- Clear, specific documentation protects both clinicians and clients, strengthening medical necessity, reducing audit risk, and supporting continuity of care. By leveraging an EHR like TheraPlatform for efficient documentation and claim submission, therapists can tackle billing with ease.
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F33.1 definition and diagnostic criteria
The F33.1 diagnosis code applies when a client has experienced more than one major depressive episode and the current episode meets criteria for moderate severity.
To diagnose Major Depressive Disorder, recurrent, clinicians rely on criteria that align closely with the DSM-5-TR while using ICD-10 coding language for billing and records. A recurrent diagnosis means the individual has had at least one prior major depressive episode separated by a period of remission lasting at least two months.
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A major depressive episode includes five or more of the following symptoms present during the same two-week period, representing a change from previous functioning. At least one symptom must be either depressed mood or loss of interest or pleasure.
Common diagnostic symptoms include:
- Depressed mood most of the day, nearly every day
- Markedly diminished interest or pleasure in most activities
- Significant weight loss or gain, or changes in appetite
- Insomnia or hypersomnia
- Psychomotor agitation or retardation observable by others
- Fatigue or loss of energy
- Feelings of worthlessness or excessive guilt
- Diminished ability to think or concentrate
- Recurrent thoughts of death or suicidal ideation
What distinguishes moderate severity from mild or severe presentations is the level of functional impairment. In moderate depression, symptoms are clearly present and distressing, and they interfere with daily functioning, work performance, relationships, or self-care. However, they do not typically involve psychotic features or the level of impairment seen in severe episodes.
Clients with F33.1 may still be able to maintain some responsibilities, but often with difficulty. They may describe getting through the day but feeling emotionally depleted, disconnected, or overwhelmed by tasks that once felt manageable.
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Common symptoms and treatment approaches
Common clinical presentation
Clients diagnosed with F33.1 often present with a combination of emotional, cognitive, behavioral, and physical symptoms. While each person’s experience of depression is unique, moderate recurrent depression tends to show certain patterns over time.
Emotionally, clients may report persistent sadness, irritability, emotional numbness, or a sense of hopelessness that feels familiar from prior depressive episodes. Many recognize the symptoms early, saying things like, “I know this feeling. I have been here before.”
Cognitively, negative self-talk and pessimistic thinking are common. Clients may struggle with concentration, decision-making, and memory. Rumination often increases, especially around perceived failures, regrets, or fears about the future.
Behaviorally, withdrawal from social activities is frequent. Clients may cancel plans, avoid communication, or reduce engagement in hobbies and interests. Motivation tends to be low, but unlike severe depression, individuals with moderate depression may still push themselves to function, which can increase exhaustion and shame.
Physically, sleep disturbances, appetite changes, and chronic fatigue are common. Somatic complaints such as headaches or gastrointestinal discomfort may also appear, particularly in clients who have difficulty expressing emotional distress directly.
Because the diagnosis is recurrent, there is often a layered emotional experience. Clients may feel discouraged not only by current symptoms but also by the fear that depression will continue to return throughout their lives.
Treatment approaches for recurrent major depressive disorder
Treatment for F33.1 typically involves psychotherapy, medication, or a combination of both. Evidence-based treatment planning considers symptom severity, history of previous episodes, client preference, and functional impact.
Psychotherapy is often a primary intervention for moderate recurrent depression. Commonly used modalities include:
- Cognitive Behavioral Therapy (CBT) helps clients identify and modify negative thought patterns and behaviors that maintain depressive symptoms
- Behavioral Activation, which focuses on increasing engagement in meaningful and rewarding activities
- Interpersonal Therapy (IPT), which addresses relationship stressors, grief, role transitions, and social functioning
- Acceptance and Commitment Therapy (ACT), which supports values-based action and psychological flexibility
- Psychodynamic or insight-oriented therapies, particularly when relational patterns or early experiences contribute to recurrent symptoms
For many clients with recurrent depression, therapy also includes relapse prevention work. This involves identifying early warning signs, developing coping strategies, and creating plans for managing future episodes more effectively.
Medication management, often involving antidepressants such as SSRIs or SNRIs, may be recommended, especially when symptoms significantly impair functioning or when previous episodes responded well to medication. Collaboration with primary care providers or psychiatrists is common and often beneficial.
Lifestyle factors are also relevant. Sleep hygiene, physical activity, social connection, and stress management can play supportive roles in treatment, though they are not substitutes for clinical care. Holistic treatment is recognized more and more as the best form of treatment.
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F33.1 related codes: F33.0, F33.2, F32.9
Understanding related ICD-10 codes allows clinicians to choose the most accurate diagnosis and avoid common documentation errors.
F33.0 Major Depressive Disorder, Recurrent, Mild
F33.0 is used when a client has a history of major depressive episodes and is currently experiencing a mild episode. Symptoms are present but cause less functional impairment. Clients may still meet diagnostic criteria, but they are often able to maintain work and relationships with fewer disruptions.
Choosing F33.0 instead of F33.1 may be appropriate when symptoms are fewer in number, less intense, or more situationally responsive.
F33.2 Major Depressive Disorder, Recurrent, Severe Without Psychotic Features
F33.2 applies when recurrent depression is severe, meaning symptoms cause marked impairment and may include profound hopelessness, inability to function, or persistent suicidal ideation. While psychotic features are not present under this code, the severity significantly impacts safety and daily living.
Accurately distinguishing between moderate and severe depression is important for treatment planning, risk assessment, and medical necessity documentation.
F32.9 Major Depressive Disorder, Single Episode, Unspecified
F32.9 is used when a client is experiencing a single depressive episode and does not yet meet criteria for recurrent depression. This code may also be used when there is insufficient information to specify severity.
Using F32.9 when a client has a documented history of prior depressive episodes can lead to inconsistencies in records and potential claim denials. Recurrent codes should be used once the clinical history supports them.
F33.1 documentation and billing tips for therapists
Accurate documentation is essential when using F33.1, both for ethical practice and for reimbursement. Payers expect clinical notes to support the diagnosis chosen, particularly for recurrent and moderate-severity codes.
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Documenting recurrent depression
When diagnosing F33.1, documentation should clearly reflect:
- A history of at least one prior major depressive episode
- A current episode that meets diagnostic criteria
- Evidence of moderate functional impairment
This information may appear in intake assessments, progress notes, or treatment plans. It does not need to be repeated verbatim in every session note, but the clinical picture should be consistent across records.
Supporting moderate severity
To justify moderate severity, notes should describe how symptoms interfere with daily functioning. Examples include difficulty maintaining work performance, strained relationships, reduced self-care, or persistent distress despite coping efforts.
Avoid vague statements such as “client feels depressed.” Instead, include observable or report-based indicators like sleep disruption, concentration problems, withdrawal, or emotional exhaustion.
Treatment planning alignment
Treatment goals and interventions should logically connect to the diagnosis. For F33.1, plans often include symptom reduction, improved functioning, relapse prevention, and skill development. Progress notes should reflect ongoing assessment of depressive symptoms and response to interventions.
Medical necessity
Payers often look for evidence that services are medically necessary. This includes documenting symptom severity, functional impairment, and the rationale for continued treatment. Using standardized measures such as the PHQ-9 can strengthen documentation, though they are not always required.
What to avoid
Even experienced clinicians can run into issues when diagnosing and documenting depressive disorders. Being aware of common pitfalls can prevent problems down the line.
Avoid using F33.1 without recurrent history
If a client has no documented history of prior depressive episodes, F33.1 may not be appropriate. In these cases, a single-episode code such as F32.x should be used until recurrence is established.
Avoid mismatched severity
Selecting a moderate code while documenting minimal symptoms can raise red flags in audits. Severity should be supported by clinical detail, not assumed.
Avoid overgeneralized language
Phrases like “doing better” or “still struggling” lack specificity. Clear descriptions of symptom changes, functioning, and client experience are more clinically meaningful and defensible.
Avoid ignoring risk assessment
Even in moderate depression, suicide risk should be assessed and documented as appropriate. Failure to address safety considerations can create ethical and legal concerns.
Avoid copy-paste documentation
Repetitive notes that do not reflect session-specific content can undermine the credibility of the record. Individualized documentation supports both client care and professional standards.
F33.1, Major Depressive Disorder, recurrent, moderate, is more than a billing code. It reflects a clinical reality that many clients live with over time. Understanding its diagnostic criteria, treatment implications, and documentation requirements helps therapists provide thoughtful, effective, and ethical care.
When used accurately, this diagnosis supports continuity of treatment, appropriate reimbursement, and a shared understanding among providers. For clients, it can also offer validation and clarity, helping them make sense of recurring struggles and approach treatment with greater self-awareness and hope.
As with all diagnoses, F33.1 should be applied with care, humility, and attention to the individual behind the code.
How EHR and practice management software can save you time with insurance billing for therapists
EHRs with integrated billing software and clearing houses, such as TheraPlatform, offer therapists significant advantages in creating an efficient insurance billing process. The key is minimizing the amount of time dedicated to developing, sending, and tracking medical claims through features such as automation and batching.
Watch this video to see how TheraPlatform’s EHR saves time on insurance billing
What are automation and batching?
- Automation refers to setting up software to perform tasks with limited human interaction.
- Batching or performing administrative tasks in blocks of time at once allows you to perform a task from a single entry point with less clicking.
Which billing and medical claim tasks can be automated and batched through billing software?
- Invoices: Create multiple invoices for multiple clients with a click or two of a button or set up auto-invoice creation, and the software will automatically create invoices for you at the preferred time. You can even have the system automatically send invoices to your clients.
- Credit card processing: Charge multiple clients with a click of a button or set up auto credit card billing, and the billing software will automatically charge the card (easier than swiping!)
- Email payment reminders: Never manually send another reminder email for payment again, or skip this altogether by enabling auto credit card charges.
- Automated claim creation and submission: Batch multiple claims with one button click or turn auto claim creation and submission on.
- Live claim validation: The system reviews each claim to catch any human errors before submission, saving you time and reducing rejected claims.
- Automated payment posting: Streamline posting procedures for paid medical claims with ERA. When insurance offers ERA, all their payments will post automatically on TheraPlatform's EHR.
- Tracking: Track payment and profits, including aging invoices, overdue invoices, transactions, billed services, service providers
Utilizing billing software integrated with an EHR and practice management software can make storing and sharing billing and insurance easy and save providers time when it comes to insurance billing for therapists.
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Resources for mental health therapists
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More resources
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- The Ultimate Insurance Billing Guide for Therapists
- The Ultimate Guide to Starting a Private Therapy Practice
- Insurance billing 101
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References
American Psychiatric Association. (2022). DSM-5-TR: Diagnostic and statistical manual of mental disorders (5th ed., text rev.).
Centers for Disease Control and Prevention. (2023). Depression: Overview and clinical considerations. https://www.cdc.gov/mental-health/?CDC_AAref_Val=https://www.cdc.gov/mentalhealth/depression
National Institute of Mental Health. (2024). Major depression. https://www.nimh.nih.gov/health/topics/depression
Substance Abuse and Mental Health Services Administration. (2023). Evidence-based practices resource center: Depression treatment. https://www.samhsa.gov/resource-search/ebp
World Health Organization.(2025) International classification of diseases (ICD-11): Depressive disorders. https://icd.who.int/browse/2025-01/mms/en#1194756772
2020 ICD-10-CM Diagnosis Code F33.1: Major depressive disorder, recurrent, moderate. (n.d.). Www.icd10data.com. https://www.icd10data.com/ICD10CM/Codes/F01-F99/F30-F39/F33-/F33.1
UpToDate. (2023). DSM-5-TR diagnostic criteria for a major depressive episode. Uptodate.com. https://www.uptodate.com/contents/image?imageKey=PSYCH%2F89994
FAQs about the F33.1 ICD-10 code
What does the ICD-10 code F33.1 mean?
F33.1 refers to Major Depressive Disorder, recurrent, moderate, indicating that a client has had at least one previous depressive episode and is currently experiencing a moderately impairing episode.
How is moderate depression different from mild or severe?
Moderate depression involves clear and persistent symptoms that interfere with daily functioning, but without psychotic features or the extreme impairment seen in severe depression.
Why is accurate documentation important for F33.1?
Because payers require evidence of recurrent history and functional impairment, detailed documentation supports medical necessity, reduces claim denials, and ensures ethical clinical practice.
