F12.951
BillableCannabis use, unspecified 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 F12.951 an HCC code?
Yes. F12.951 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 F12.951
For F12.951 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 F12.951 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F12.951 is the ICD-10-CM diagnosis code for cannabis use, unspecified with psychotic disorder with hallucinations. A person uses cannabis in an unspecified pattern and is experiencing a mental health condition involving hallucinations (seeing or hearing things that aren't real). This code indicates the cannabis use and psychotic symptoms are related. F12.951 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, F12.951 maps to Drug/Alcohol Psychosis (HCC 135) with a community, non-dual, aged base RAF weight of 0.000. Under the older V24 model, F12.951 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.
Verify documentation clearly links cannabis use to the psychotic symptoms with hallucinations; if the relationship is unclear, query the provider before coding. Because F12.951 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 F12.951 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify documentation clearly links cannabis use to the psychotic symptoms with hallucinations; if the relationship is unclear, query the provider before coding
- •Ensure the cannabis use pattern is documented; if specific frequency/remission status cannot be determined, 'unspecified' is appropriate, but check for any documentation of use severity
Clinical Significance
Cannabis use, unspecified with psychotic disorder with hallucinations documents cannabis-induced psychosis featuring hallucinations when the use disorder severity is not specified. Hallucinations persisting beyond intoxication in the context of cannabis use represent a significant psychiatric emergency. This diagnosis is important for both clinical management and risk adjustment, as it captures the highest substance use HCC category in the V24 model.
Documentation Requirements
- ✓Documentation of cannabis use
- ✓Description of specific hallucinations (auditory, visual, tactile, olfactory)
- ✓Clinical statement that hallucinations are cannabis-induced
- ✓Evidence that hallucinations persist beyond the intoxication period
- ✓Mental status examination documenting hallucinatory experiences
- ✓Exclusion of primary psychotic disorders and other causes of hallucinations