F12.950
BillableCannabis use, unspecified with psychotic disorder with delusions
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F12.950 an HCC code?
Yes. F12.950 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 F12.950
For F12.950 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 F12.950 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F12.950 is the ICD-10-CM diagnosis code for cannabis use, unspecified with psychotic disorder with delusions. A person who uses cannabis without dependence and experiences psychotic symptoms including delusions (false beliefs) caused by the cannabis use. F12.950 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, F12.950 maps to Drug/Alcohol Psychosis (HCC 135) with a community, non-dual, aged base RAF weight of 0.000. Under the older V24 model, F12.950 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.
Document that delusions are present and related to cannabis use; distinguish from other causes of psychosis. Because F12.950 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 F12.950 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document that delusions are present and related to cannabis use; distinguish from other causes of psychosis
- •Verify that psychotic symptoms persist beyond the period of acute intoxication to confirm cannabis-induced psychotic disorder
Clinical Significance
Cannabis use, unspecified with psychotic disorder with delusions identifies a patient with cannabis-induced psychosis featuring delusions when the severity of the use disorder is not documented. Cannabis-induced psychosis with delusions is a serious psychiatric condition that significantly increases healthcare utilization and carries prognostic significance for potential development of primary psychotic disorders. Despite the unspecified use pattern, this code captures the critical psychotic complication.
Documentation Requirements
- ✓Documentation of cannabis use
- ✓Description of specific delusions (persecutory, grandiose, referential, etc.)
- ✓Clinical statement that psychotic disorder is induced by cannabis
- ✓Evidence that delusions persist beyond acute intoxication
- ✓Mental status examination documenting delusional thinking
- ✓Exclusion of primary psychotic disorders
Commonly Confused Codes
- •F12.150 — Cannabis abuse with psychotic disorder with delusions; use when abuse is documented
- •F12.250 — Cannabis dependence with psychotic disorder with delusions; use when dependence is documented
- •F12.951 — Cannabis use, unspecified with psychotic disorder with hallucinations; use when hallucinations are the primary feature
- •F22 — Delusional disorder; use for primary delusional disorder not substance-induced