F11.151
BillableOpioid abuse with opioid-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 F11.151 an HCC code?
Yes. F11.151 maps to Drug/Alcohol Psychosis 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 F11.151
For F11.151to 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 F11.151 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F11.151 is the ICD-10-CM diagnosis code for opioid abuse with opioid-induced psychotic disorder with hallucinations. A person who misuses opioids and experiences hallucinations as a direct result of the opioid use, such as seeing or hearing things that aren't there. F11.151 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, F11.151 maps to Drug/Alcohol Psychosis (HCC 135) with a community, non-dual, aged base RAF weight of 0.000. Under the older V24 model, F11.151 mapped to the same category but with a base RAF weight of 0.434 — V28 recalibrated weights across the entire model. 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.
Document the specific hallucinations (visual, auditory, tactile) when present in the clinical record. Because F11.151 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 F11.151 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document the specific hallucinations (visual, auditory, tactile) when present in the clinical record
- •Ensure documentation clearly links the psychotic symptoms to opioid abuse rather than a primary psychotic disorder
Clinical Significance
Opioid abuse with opioid-induced psychotic disorder with hallucinations indicates opioid misuse is causing false sensory perceptions such as visual, auditory, or tactile hallucinations. This serious psychiatric complication requires differentiation from primary psychotic disorders and delirium, and indicates high clinical acuity.
Documentation Requirements
- ✓Provider documentation of opioid abuse
- ✓Documentation of specific hallucination types (visual, auditory, tactile, olfactory)
- ✓Statement that hallucinations are opioid-induced
- ✓Temporal relationship between opioid use and hallucination onset
- ✓Mental status examination findings
- ✓Assessment ruling out primary psychotic disorders and delirium
- ✓Safety assessment and treatment plan
Commonly Confused Codes
- •F11.150 — Opioid abuse with psychotic disorder with delusions: use when fixed false beliefs (not perceptions) are present
- •F11.159 — Opioid abuse with psychotic disorder, unspecified: use only when psychotic type is not documented
- •F11.251 — Opioid dependence with psychotic disorder with hallucinations: use when dependence is documented
- •F11.122 — Opioid abuse with intoxication with perceptual disturbance: use when hallucinations occur during intoxication specifically