F13.151
BillableSedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-induced psychotic disorder with hallucinations
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F13.151 an HCC code?
Yes. F13.151 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 F13.151
For F13.151 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 F13.151 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F13.151 is the ICD-10-CM diagnosis code for sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-induced psychotic disorder with hallucinations. Misuse of sedatives, sleeping pills, or anti-anxiety medications that causes psychotic symptoms, specifically seeing or hearing things that aren't real (hallucinations). F13.151 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, F13.151 maps to Drug/Alcohol Psychosis (HCC 135) with a community, non-dual, aged base RAF weight of 0.000. Under the older V24 model, F13.151 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.
Specify the type of hallucinations (auditory, visual, tactile) in documentation when available. Because F13.151 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 F13.151 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 (auditory, visual, tactile) in documentation when available
- •This code reflects substance-induced hallucinations rather than primary psychotic disorder
Clinical Significance
Sedative-induced hallucinations during abuse represent an acute psychiatric emergency where the patient is perceiving things that are not real, directly caused by substance misuse. This condition requires differentiation from primary psychotic disorders and carries implications for patient safety and treatment planning. The higher HCC mapping to Drug/Alcohol Psychosis reflects the clinical severity of this presentation.
Documentation Requirements
- ✓Identification of the specific sedative, hypnotic, or anxiolytic substance being abused
- ✓Type of hallucinations documented (auditory, visual, tactile, olfactory)
- ✓Temporal relationship between substance use and onset of hallucinations
- ✓Clinical distinction from primary psychotic disorders documented in assessment
- ✓Pattern of use meeting abuse criteria (not dependence)
- ✓Mental status examination documenting hallucination findings
Commonly Confused Codes
- •F13.150 — Sedative abuse with delusions rather than hallucinations; delusions are false beliefs, not false perceptions
- •F13.159 — Unspecified psychotic disorder from sedative abuse; use only when hallucinations vs delusions cannot be determined
- •F13.251 — Sedative DEPENDENCE with hallucinations; requires dependence criteria rather than abuse
- •F13.232 — Sedative dependence withdrawal with perceptual disturbance; occurs during withdrawal, not active intoxication
- •F10.151 — Alcohol abuse with psychotic disorder with hallucinations; wrong substance category