F12.250 ICD-10-CM Code: Cannabis dependence with psychotic disorder with delusions
F12.250 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 · HCC Buddy 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)
F12.250
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceCannabis dependence with psychotic disorder with delusions
A person dependent on cannabis who has developed a psychotic disorder with delusions (false beliefs) as a result of their cannabis use.
Buddy Insight
Cannabis dependence with psychotic disorder with delusions is a severe psychiatric diagnosis indicating that cannabis dependence has led to a persistent psychotic state featuring false fixed beliefs.
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 F12.250. 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, F12.2
- cannabis poisoning (T40.7-)Inherited from F01-F99, F12.2
Related Codes
Includes
Official- disorders of psychological developmentInherited from F01-F99, F12
- marijuanaInherited from F01-F99, F12
Excludes 1
Official- cannabis abuse (F12.1-)Inherited from F12.2
- cannabis use, unspecified (F12.9-)Inherited from F12.2
Code First
OfficialNo Code First sequencing instructions are included in this display for F12.250. Check the code and parent instructions in the Code Book.
Use Additional
OfficialNo Use Additional Code instructions are included in this display for F12.250. Check the code and parent instructions in the Code Book.
Code Also
OfficialNo Code Also instructions are included in this display for F12.250. 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 F12.250 an HCC code?
Yes. F12.250 (Cannabis dependence with psychotic disorder with delusions) 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: F12.250 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
- F12.250
- Description
- Cannabis dependence with psychotic disorder with delusions
- 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 F12.250 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for F12.250
For F12.250, 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
F12.250 is the ICD-10-CM diagnosis code for cannabis dependence with psychotic disorder with delusions. A person dependent on cannabis who has developed a psychotic disorder with delusions (false beliefs) as a result of their cannabis use. F12.250 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, F12.250 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.
Ensure documentation distinguishes between cannabis-induced psychosis and primary psychotic disorders. For F12.250, 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 F12.250 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Ensure documentation distinguishes between cannabis-induced psychosis and primary psychotic disorders
- •Document the specific delusions and their temporal relationship to cannabis use
Clinical Significance
Cannabis dependence with psychotic disorder with delusions is a severe psychiatric diagnosis indicating that cannabis dependence has led to a persistent psychotic state featuring false fixed beliefs. This is among the most serious cannabis-related psychiatric complications and carries significant prognostic implications. Research shows cannabis-induced psychosis with delusions in dependent patients has a higher rate of conversion to primary psychotic disorders such as schizophrenia.
Documentation Requirements
- ✓Documentation of cannabis dependence criteria
- ✓Description of specific delusions (type, content, severity)
- ✓Clinical statement that psychotic disorder is induced by cannabis
- ✓Evidence that delusions persist beyond acute intoxication
- ✓Mental status examination documenting psychotic features
- ✓Exclusion of primary psychotic disorders (schizophrenia, delusional disorder)
- ✓Treatment plan addressing both dependence and psychosis
Commonly Confused Codes
- •F12.251: Cannabis dependence with psychotic disorder with hallucinations; use when hallucinations are the primary feature
- •F12.259: Cannabis dependence with psychotic disorder, unspecified; use when specific psychotic features are not documented
- •F12.150: Cannabis abuse with psychotic disorder with delusions; use when only abuse is documented
- •F22: Delusional disorder; use for primary delusional disorder not induced by substances