F12.259 ICD-10-CM Code: Cannabis dependence with psychotic disorder, unspecified
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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)
F12.259
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceCannabis dependence with psychotic disorder, unspecified
This code describes a patient who is dependent on cannabis (marijuana) and experiences psychotic symptoms such as hallucinations or delusions, but the specific type of psychotic disorder has not been identified. The psychotic symptoms are directly related to the cannabis use.
Buddy Insight
Cannabis dependence with unspecified psychotic disorder captures a dependent patient with cannabis-induced psychosis when the specific type of psychotic features is not documented.
CMS-HCC V28
MappedHCC 135
RAF 0.424
CMS-HCC V24
MappedHCC 54
RAF 0.329
ACA/HHS
MappedHCC 81
Varies by metal level
ESRD/PACE
MappedHCC 54
RAF 0.111
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for F12.259 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for F12.259 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for F12.259 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for F12.259 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for F12.259 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for F12.259 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for F12.259 in this effective period.
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 F12.259 an HCC code?
Yes. F12.259 (Cannabis dependence with psychotic disorder, unspecified) 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: F12.259 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
- F12.259
- Description
- Cannabis dependence with psychotic disorder, unspecified
- HCC (V28)
- HCC 135 — Drug Use with Psychotic Complications
- RAF
- 0.424
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
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 F12.259 in the Code Book — tabular path, V28 RAF, and MEAT checklist →
MEAT Criteria for F12.259
For F12.259 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 F12.259 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
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What This Code Means
F12.259 is the ICD-10-CM diagnosis code for cannabis dependence with psychotic disorder, unspecified. This code describes a patient who is dependent on cannabis (marijuana) and experiences psychotic symptoms such as hallucinations or delusions, but the specific type of psychotic disorder has not been identified. The psychotic symptoms are directly related to the cannabis use. F12.259 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, F12.259 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, F12.259 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.
Verify documentation clearly states both cannabis dependence AND a psychotic disorder; if only one condition is present, use a different code. Because F12.259 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 F12.259 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify documentation clearly states both cannabis dependence AND a psychotic disorder; if only one condition is present, use a different code
- •If the specific psychotic disorder is documented (such as schizophreniform disorder or brief psychotic disorder), use the more specific F12.25x code rather than the unspecified variant
Clinical Significance
Cannabis dependence with unspecified psychotic disorder captures a dependent patient with cannabis-induced psychosis when the specific type of psychotic features is not documented. While this still maps to the highest substance use HCC category (HCC 54 in V24), more specific documentation of delusions versus hallucinations would improve clinical precision. This code indicates serious psychiatric comorbidity requiring both addiction and psychiatric treatment.
Documentation Requirements
- ✓Documentation of cannabis dependence
- ✓Statement that psychotic disorder is present and cannabis-induced
- ✓Any available clinical details about the psychotic presentation
- ✓Evidence that provider was queried about specific psychotic features
- ✓Temporal relationship between cannabis use and psychosis
Commonly Confused Codes
- •F12.250: Cannabis dependence with psychotic disorder with delusions; use when delusions are specified
- •F12.251: Cannabis dependence with psychotic disorder with hallucinations; use when hallucinations are specified
- •F12.20: Cannabis dependence, uncomplicated; use when no psychotic disorder is present
- •F29: Unspecified psychosis not due to a substance; use when psychosis is not substance-induced