F15.251
BillableOther stimulant dependence with stimulant-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 F15.251 an HCC code?
Yes. F15.251 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 F15.251
For F15.251 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 F15.251 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F15.251 is the ICD-10-CM diagnosis code for other stimulant dependence with stimulant-induced psychotic disorder with hallucinations. A person dependent on stimulants who has developed psychosis with hallucinations, which are false sensory experiences (seeing, hearing, or feeling things that aren't real) caused by stimulant use. F15.251 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, F15.251 maps to Drug/Alcohol Psychosis (HCC 135) with a community, non-dual, aged base RAF weight of 0.000. Under the older V24 model, F15.251 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 psychotic symptoms with specific mention of hallucinations (false sensory perceptions). Because F15.251 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 F15.251 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document psychotic symptoms with specific mention of hallucinations (false sensory perceptions)
- •Specify the type of hallucinations (visual, auditory, tactile) when documented for clinical clarity
Clinical Significance
Stimulant dependence with stimulant-induced psychotic disorder with hallucinations represents severe psychiatric pathology where chronic stimulant dependence has produced persistent hallucinatory experiences. Stimulant-induced hallucinations are commonly tactile (formication — sensation of bugs crawling on skin) or auditory, and can be difficult to distinguish from primary psychotic disorders. This diagnosis carries the highest risk adjustment weight in the substance use hierarchy.
Documentation Requirements
- ✓Documented stimulant dependence
- ✓Hallucinations specifically described with type (auditory, visual, tactile)
- ✓Temporal relationship between stimulant use and hallucination onset
- ✓Documentation distinguishing substance-induced hallucinations from primary psychotic disorder
- ✓Psychiatric assessment documenting the severity and impact of hallucinations
- ✓Treatment plan for both psychotic symptoms and dependence
Commonly Confused Codes
- •F15.250 — Stimulant dependence with psychotic disorder with delusions; delusions vs. hallucinations as predominant feature
- •F15.222 — Stimulant dependence with intoxication with perceptual disturbance; transient vs. persistent hallucinatory state
- •F15.151 — Stimulant abuse with psychotic disorder with hallucinations; requires abuse rather than dependence
- •F20.9 — Schizophrenia, unspecified; primary psychotic disorder, not substance-induced