What is ICD-10 code F12.251?

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 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. F12.251 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. F12.251 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. F12.251 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

What is the V28 vs V24 difference for F12.251?

CMS phased in the V28 risk adjustment model over payment years 2024 (33%), 2025 (67%), and 2026 (100%), replacing V24. V28 consolidates HCC categories, removes some lower-acuity conditions, and recalibrates RAF weights across the entire model. For F12.251, V28 maps to Drug Use with Psychotic Complications at RAF 0.424 while V24 mapped to Substance Use with Psychotic Complications at RAF 0.329. Both models can still appear in legacy data and in payer-specific lookback periods.

What should coders know when reporting F12.251?

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 Because F12.251 maps to a payment HCC, the documentation must also satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's risk adjustment score.

2026 ICD-10-CM F12.251: Cannabis dependence

ICD-10-CM Code View

HCC Buddy Code Card

Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.

Code lookupF12.251Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Mental, Behavioral and Neurodevelopmental disorders (F01-F99) / Mental and behavioral disorders due to psychoactive substance use (F10-F19)

F12.251

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

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.

Buddy Insight

Cannabis dependence with psychotic disorder with hallucinations captures a severe presentation where a dependent patient develops persistent hallucinations attributed to cannabis use.

CMS-HCC V28

Mapped

HCC 135

Drug Use with Psychotic Compl...

RAF 0.424

CMS-HCC V24

Mapped

HCC 54

Substance Use with Psychotic ...

RAF 0.329

ACA/HHS

Mapped

HCC 81

HHS-HCC 81

Varies by metal level

ESRD/PACE

Mapped

HCC 54

Substance Use with Psychotic ...

RAF 0.111

RXHCC

N/A

—

Not risk-adjusted for this model/period.

Not mapped

Code Book Path

Official

F12.2Cannabis dependence

F12.25Cannabis dependence with psychotic disorder

F12.251Cannabis dependence with psychotic disorder with hallucinations

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for F12.251 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for F12.251 in this effective period.

Related Child Codes

Official

F12.250Cannabis dependence with psychotic disorder with delusions

F12.259Cannabis dependence with psychotic disorder, unspecified

Includes

Official

ICD-10-CM does not list Includes notes for F12.251 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for F12.251 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for F12.251 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for F12.251 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for F12.251 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

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

MEAT Support

HCC Buddy guidance

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

Audit Caution

HCC Buddy guidance

Coding intoxication-related perceptual disturbances as psychotic disorder — psychosis must persist beyond intoxication

Assigning primary schizophrenia codes when the psychosis is clearly linked to cannabis dependence

Using unspecified psychotic disorder code when hallucinations are specifically documented

Failing to establish the temporal and causal relationship between cannabis use and psychotic symptoms

Common Mistakes

HCC Buddy guidance

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

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 F12.251 an HCC code?

Yes. F12.251 (Cannabis dependence with psychotic disorder with hallucinations) maps to Drug Use with Psychotic Complications under the CMS-HCC V28 risk adjustment model (and Substance Use with Psychotic Complications under V24), with a community non-dual aged RAF of 0.424. It is billable for payment year 2026.

Coder answer: F12.251 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: F12.251
Description: Cannabis dependence with psychotic disorder with hallucinations
HCC (V28): HCC 135 — Drug Use with Psychotic Complications
RAF: 0.424
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 135, Drug Use with Psychotic Complications

0.424

V24HCC 54, Substance Use with Psychotic Complications

0.329

ESRDHCC 54, Substance Use with Psychotic Complications

0.111

Each model's RAF is its CMS base weight for that model's standard population, so 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 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.

Work F12.251 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

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.

Coder workflow notes

Get the V28 RAF + MEAT cheat sheet

One printable page: confirm a code's V28 HCC status, its RAF weight, and the MEAT your note needs to make it stick. Free, no card.

Free PDF. No card. Unsubscribe anytime.

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 Use with Psychotic Complications (HCC 135) with a community, non-dual, aged base RAF weight of 0.424. Under the older CMS-HCC V24 model, F12.251 maps to Substance Use with Psychotic Complications (HCC 54) with a community, non-dual, aged base RAF weight of 0.329. 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