F11.151 ICD-10-CM Code: Opioid abuse with opioid-induced psychotic disorder with hallucinations
F11.151 maps to CMS-HCC V28 135. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · free HCC coding tools
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FY 2026 Apr update / Mental, Behavioral and Neurodevelopmental disorders (F01-F99) / Mental and behavioral disorders due to psychoactive substance use (F10-F19)
F11.151
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceOpioid 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.
Buddy Insight
Opioid abuse with opioid-induced psychotic disorder with hallucinations indicates opioid misuse is causing false sensory perceptions such as visual, auditory, or tactile hallucinations.
CMS-HCC V28
MappedHCC 135
Coefficient HCC 135: 0.424 (Community Non-Dual Aged (CNA))
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
MappedHCC 081
Code-level coefficient reference
ESRD/PACE
MappedHCC 54
Code-level coefficient reference
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
OfficialNo inclusion terms are included in this display for F11.151. Check the code and parent instructions in the Code Book.
Excludes 2
Official- symptoms, signs and abnormal clinical laboratory findings, not elsewhere classified (R00-R99)Inherited from F01-F99
Related Codes
Includes
Official- disorders of psychological developmentInherited from F01-F99
Excludes 1
Official- opioid dependence (F11.2-)Inherited from F11.1
- opioid use, unspecified (F11.9-)Inherited from F11.1
Code First
OfficialNo Code First sequencing instructions are included in this display for F11.151. Check the code and parent instructions in the Code Book.
Use Additional
OfficialNo Use Additional Code instructions are included in this display for F11.151. Check the code and parent instructions in the Code Book.
Code Also
OfficialNo Code Also instructions are included in this display for F11.151. Check the code and parent instructions in the Code Book.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →
Is F11.151 an HCC code?
Yes. F11.151 (Opioid abuse with opioid-induced psychotic disorder with hallucinations) maps to HCC 135, Drug Use with Psychotic Complications under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.424. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.
Coder answer: F11.151 is billable and maps to V28 HCC 135, Drug Use with Psychotic Complications. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.
- Code
- F11.151
- Description
- Opioid abuse with opioid-induced psychotic disorder with hallucinations
- HCC (V28)
- HCC 135 — Drug Use with Psychotic Complications
- RAF reference coefficient
- 0.424
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. Weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.
Work F11.151 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for F11.151
For F11.151, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.
- 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
Coder workflow notes
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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 Use with Psychotic Complications (HCC 135) with a source-labeled community, non-dual, aged reference coefficient of 0.424. For CY2026 non-PACE Medicare Advantage, CMS uses 100% of the 2024 CMS-HCC model (V28). PACE uses a separate model blend. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.
Document the specific hallucinations (visual, auditory, tactile) when present in the clinical record. For F11.151, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule. 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, source-labeled coefficient references, 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