F13.950
BillableSedative, hypnotic or anxiolytic use, unspecified 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 F13.950 an HCC code?
Yes. F13.950 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 F13.950
For F13.950to 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 F13.950 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F13.950 is the ICD-10-CM diagnosis code for sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced psychotic disorder with delusions. A person is experiencing delusions (false beliefs) caused by sedative, hypnotic, or anti-anxiety medication use. F13.950 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, F13.950 maps to Drug/Alcohol Psychosis (HCC 135) with a community, non-dual, aged base RAF weight of 0.000. Under the older V24 model, F13.950 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 the content and nature of delusions and confirm they are substance-induced rather than primary psychotic disorder. Because F13.950 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 F13.950 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document the content and nature of delusions and confirm they are substance-induced rather than primary psychotic disorder
- •Note the timeline of substance use relative to onset of delusions
Clinical Significance
Unspecified sedative use with induced psychotic disorder featuring delusions represents a serious psychiatric complication where the patient has developed fixed false beliefs from sedative use. The unspecified use pattern is secondary to the severity of the psychotic presentation. This maps to the highest substance use HCC category and requires urgent psychiatric assessment.
Documentation Requirements
- ✓Documentation of sedative, hypnotic, or anxiolytic use
- ✓Detailed description of delusions (content, type, persistence)
- ✓Clinical evidence that delusions are substance-induced, not primary psychotic disorder
- ✓Mental status examination with psychotic symptom documentation
- ✓Timeline of substance use and delusional onset
- ✓Safety assessment and treatment plan
Commonly Confused Codes
- •F13.951 — Unspecified use with induced hallucinations; different psychotic symptom type
- •F13.959 — Unspecified use with unspecified psychotic disorder; use when symptom type is unknown
- •F13.150 — Sedative ABUSE with psychotic disorder with delusions; when abuse is confirmed
- •F13.250 — Sedative DEPENDENCE with psychotic disorder with delusions; when dependence is confirmed
- •F22 — Delusional disorders; primary psychotic disorder, not substance-induced