F12.251
BillableCannabis dependence with psychotic disorder with hallucinations
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F12.251 an HCC code?
Yes. F12.251 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 F12.251
For F12.251 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 F12.251 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F12.251 is the ICD-10-CM diagnosis code for cannabis dependence with psychotic disorder with hallucinations. A person dependent on cannabis who has developed a psychotic disorder with hallucinations (seeing or hearing things that aren't real) as a result of their cannabis use. F12.251 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, F12.251 maps to Drug/Alcohol Psychosis (HCC 135) with a community, non-dual, aged base RAF weight of 0.000. Under the older V24 model, F12.251 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.
Specify the type of hallucinations (visual, auditory, tactile, etc.) in the clinical documentation. Because F12.251 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 F12.251 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Specify the type of hallucinations (visual, auditory, tactile, etc.) in the clinical documentation
- •Document the temporal relationship between cannabis use and onset of hallucinations to support cannabis-induced diagnosis
Clinical Significance
Cannabis dependence with psychotic disorder with hallucinations captures a severe presentation where a dependent patient develops persistent hallucinations attributed to cannabis use. This is a high-acuity psychiatric condition requiring intensive treatment. The presence of hallucinations in the context of cannabis dependence may indicate a vulnerability to psychotic disorders and warrants careful psychiatric follow-up and substance use treatment coordination.
Documentation Requirements
- ✓Documentation of cannabis dependence criteria
- ✓Description of specific hallucinations (auditory, visual, tactile, or other modality)
- ✓Statement that hallucinations are induced by cannabis use
- ✓Evidence that hallucinations persist beyond the acute intoxication period
- ✓Mental status examination documenting hallucinatory experiences
- ✓Exclusion of schizophrenia, schizoaffective disorder, and other primary psychotic disorders
Commonly Confused Codes
- •F12.250 — Cannabis dependence with psychotic disorder with delusions; use when delusions are the primary feature
- •F12.222 — Cannabis dependence with intoxication with perceptual disturbance; use when hallucinations are limited to intoxication
- •F12.151 — Cannabis abuse with psychotic disorder with hallucinations; use when only abuse is documented
- •F20.0 — Paranoid schizophrenia; use only for primary psychotic disorder, not substance-induced