F14.951
BillableCocaine use, unspecified with cocaine-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 F14.951 an HCC code?
Yes. F14.951 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 F14.951
For F14.951 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 F14.951 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F14.951 is the ICD-10-CM diagnosis code for cocaine use, unspecified with cocaine-induced psychotic disorder with hallucinations. A person using cocaine who is experiencing psychosis with hallucinations (seeing, hearing, or sensing things that aren't real) caused by the cocaine use. F14.951 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, F14.951 maps to Drug/Alcohol Psychosis (HCC 135) with a community, non-dual, aged base RAF weight of 0.000. Under the older V24 model, F14.951 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.
Specify the type of hallucinations (visual, auditory, tactile) in documentation when available. Because F14.951 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 F14.951 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 (visual, auditory, tactile) in documentation when available
- •Ensure hallucinations are attributed to cocaine use rather than other psychiatric or medical conditions
Clinical Significance
Cocaine use, unspecified with cocaine-induced psychotic disorder with hallucinations captures a patient experiencing cocaine-induced hallucinations where the use pattern is not specified. Cocaine hallucinations are characteristically tactile (formication), visual, or auditory, and indicate significant neurotoxicity. This condition can lead to self-injurious behavior, particularly skin excoriation from tactile hallucinations. It maps to the higher-weighted psychosis HCC in V24.
Documentation Requirements
- ✓Documentation of cocaine use
- ✓Clear documentation that hallucinations are cocaine-induced
- ✓Description of hallucination type (tactile, visual, auditory, olfactory)
- ✓Documentation excluding primary psychotic disorders
- ✓Temporal relationship between cocaine use and hallucination onset
- ✓Mental status examination
- ✓Assessment of patient response to hallucinations and safety risk
Commonly Confused Codes
- •F14.151 — Cocaine abuse with cocaine-induced psychotic disorder with hallucinations: use when abuse is established
- •F14.251 — Cocaine dependence with cocaine-induced psychotic disorder with hallucinations: use when dependence is established
- •F14.950 — Cocaine use, unspecified with cocaine-induced psychotic disorder with delusions: use when delusions are the primary symptom
- •F14.922 — Cocaine use, unspecified with intoxication with perceptual disturbance: use for transient perceptual changes not meeting psychosis criteria
- •F14.959 — Cocaine use, unspecified with cocaine-induced psychotic disorder, unspecified: use when psychosis type is not specified