F10.951
BillableAlcohol use, unspecified with alcohol-induced psychotic disorder with hallucinations
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F10.951 an HCC code?
Yes. F10.951 maps to Alcohol Use with Psychotic Complications under the CMS-HCC V28 risk adjustment model (and Drug/Alcohol Psychosis under V24).
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.
MEAT Criteria for F10.951
For F10.951 to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically — it has to be re-documented and supported each calendar year.
- MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
- EEvaluate: test results, medication response, or physical findings reviewed by the provider
- AAssess: explicit mention in the assessment or plan with acknowledgment of status
- TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis
Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed F10.951 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F10.951 is the ICD-10-CM diagnosis code for alcohol use, unspecified with alcohol-induced psychotic disorder with hallucinations. A serious mental condition where alcohol use causes psychotic symptoms, specifically seeing, hearing, or sensing things that are not actually present. F10.951 sits in the ICD-10-CM chapter for mental, behavioral and neurodevelopmental disorders (f01-f99), within the section covering mental and behavioral disorders due to psychoactive substance use (f10-f19).
Under the CMS-HCC V28 risk adjustment model, F10.951 maps to Alcohol Use with Psychotic Complications (HCC 136) with a community, non-dual, aged base RAF weight of 0.275. Under the older CMS-HCC V24 model, F10.951 maps to Drug/Alcohol Psychosis (HCC 54) with a community, non-dual, aged base RAF weight of 0.434. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.
Clearly document the type of hallucinations (auditory, visual, tactile, etc.) in the medical record. Because F10.951 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for F10.951 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Clearly document the type of hallucinations (auditory, visual, tactile, etc.) in the medical record
- •Confirm the hallucinations are directly attributable to alcohol use and not another underlying psychiatric condition
Clinical Significance
Alcohol-induced psychotic disorder with hallucinations indicates alcohol use is causing false sensory perceptions, most commonly visual or auditory hallucinations. This is a serious complication that may occur during active intoxication or withdrawal and requires immediate clinical attention. It reflects high disease burden and resource utilization for risk adjustment purposes.
Documentation Requirements
- ✓Type of hallucinations documented (visual, auditory, tactile, olfactory)
- ✓Temporal relationship between alcohol use/withdrawal and hallucination onset
- ✓Provider statement that hallucinations are alcohol-induced, not from a primary psychiatric disorder
- ✓Mental status examination documenting psychotic features
- ✓Alcohol use history (frequency, quantity, duration)
- ✓Treatment and safety plan
Commonly Confused Codes
- •F10.950 — Alcohol use, unspecified with psychotic disorder with delusions: use when false beliefs, not false perceptions, are present
- •F10.931 — Alcohol use, unspecified with withdrawal delirium: use when hallucinations occur as part of delirium tremens during withdrawal
- •F10.251 — Alcohol dependence with psychotic disorder with hallucinations: use when dependence is documented
- •F20.9 — Schizophrenia, unspecified: use only when psychosis is NOT alcohol-induced