F15.259
BillableOther stimulant dependence with stimulant-induced psychotic disorder, unspecified
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F15.259 an HCC code?
Yes. F15.259 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 F15.259
For F15.259 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 F15.259 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F15.259 is the ICD-10-CM diagnosis code for other stimulant dependence with stimulant-induced psychotic disorder, unspecified. A person who is dependent on stimulant drugs (like cocaine or amphetamines) and is experiencing psychotic symptoms such as hallucinations or delusions as a direct result of the drug use. F15.259 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, F15.259 maps to Drug/Alcohol Psychosis (HCC 135) with a community, non-dual, aged base RAF weight of 0.000. Under the older V24 model, F15.259 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 whether the psychotic disorder is with or without hallucinations/delusions to support medical necessity. Because F15.259 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 F15.259 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document whether the psychotic disorder is with or without hallucinations/delusions to support medical necessity
- •Verify the stimulant type (cocaine, amphetamine, other) is documented to ensure accurate coding of the primary substance
Clinical Significance
Stimulant dependence with unspecified psychotic disorder indicates psychotic features are present but not further characterized as delusions or hallucinations. While this still maps to the highest substance use HCC, it reflects incomplete documentation that should prompt a provider query. Specifying the psychotic manifestation supports better clinical care and stronger audit defensibility.
Documentation Requirements
- ✓Documented stimulant dependence
- ✓Evidence of psychotic symptoms attributed to stimulant use
- ✓Query to provider to specify whether delusions, hallucinations, or both are present
- ✓Documentation that psychosis is substance-induced
- ✓Treatment plan addressing the psychotic disorder and underlying dependence