F13.150
BillableSedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-induced psychotic disorder with delusions
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F13.150 an HCC code?
Yes. F13.150 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 F13.150
For F13.150 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 F13.150 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F13.150 is the ICD-10-CM diagnosis code for sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-induced psychotic disorder with delusions. Misuse of sedatives, sleeping pills, or anti-anxiety medications that causes psychotic symptoms, specifically false beliefs (delusions). F13.150 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, F13.150 maps to Drug/Alcohol Psychosis (HCC 135) with a community, non-dual, aged base RAF weight of 0.000. Under the older V24 model, F13.150 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 the content of delusions when possible to support medical necessity. Because F13.150 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 F13.150 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document the content of delusions when possible to support medical necessity
- •Distinguish between substance-induced psychosis (this code) and primary psychotic disorders
Clinical Significance
Sedative-induced psychotic disorder with delusions in the context of abuse represents a serious psychiatric complication requiring immediate clinical attention. This diagnosis indicates the substance use has progressed beyond simple misuse to cause significant reality distortion. Accurate capture is critical for risk adjustment as it maps to a higher-severity psychosis HCC rather than simple substance abuse.
Documentation Requirements
- ✓Documentation of the specific sedative, hypnotic, or anxiolytic substance being abused
- ✓Description of the delusional content (persecutory, grandiose, jealous, etc.)
- ✓Temporal relationship establishing that delusions began during or shortly after substance use
- ✓Clinical assessment ruling out primary psychotic disorders (schizophrenia, schizoaffective disorder)
- ✓Current pattern of use meeting criteria for abuse (not dependence)
- ✓Mental status examination findings supporting psychotic symptoms