What is ICD-10 code F15.259?

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 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. F15.259 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. F15.259 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. F15.259 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

What is the V28 vs V24 difference for F15.259?

CMS phased in the V28 risk adjustment model over payment years 2024 (33%), 2025 (67%), and 2026 (100%), replacing V24. V28 consolidates HCC categories, removes some lower-acuity conditions, and recalibrates RAF weights across the entire model. For F15.259, V28 maps to Drug Use with Psychotic Complications at RAF 0.424 while V24 mapped to Substance Use with Psychotic Complications at RAF 0.329. Both models can still appear in legacy data and in payer-specific lookback periods.

What should coders know when reporting F15.259?

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 Because F15.259 maps to a payment HCC, the documentation must also satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's risk adjustment score.

2026 ICD-10-CM F15.259: Other stimulant dependence

ICD-10-CM Code View

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Code lookupF15.259Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Mental, Behavioral and Neurodevelopmental disorders (F01-F99) / Mental and behavioral disorders due to psychoactive substance use (F10-F19)

F15.259

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

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.

Buddy Insight

Stimulant dependence with unspecified psychotic disorder indicates psychotic features are present but not further characterized as delusions or hallucinations.

CMS-HCC V28

Mapped

HCC 135

Drug Use with Psychotic Compl...

RAF 0.424

CMS-HCC V24

Mapped

HCC 54

Substance Use with Psychotic ...

RAF 0.329

ACA/HHS

Mapped

HCC 81

HHS-HCC 81

Varies by metal level

ESRD/PACE

Mapped

HCC 54

Substance Use with Psychotic ...

RAF 0.111

RXHCC

N/A

—

Not risk-adjusted for this model/period.

Not mapped

Code Book Path

Official

F15.2Other stimulant dependence

F15.25Other stimulant dependence with stimulant-induced psychotic disorder

F15.259Other stimulant dependence with stimulant-induced psychotic disorder, unspecified

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for F15.259 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for F15.259 in this effective period.

Related Child Codes

Official

F15.250Other stimulant dependence with stimulant-induced psychotic disorder with delusions

F15.251Other stimulant dependence with stimulant-induced psychotic disorder with hallucinations

Includes

Official

ICD-10-CM does not list Includes notes for F15.259 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for F15.259 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for F15.259 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for F15.259 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for F15.259 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

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

MEAT Support

HCC Buddy guidance

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

Audit Caution

HCC Buddy guidance

Defaulting to this code when the record actually specifies delusions or hallucinations

Accepting vague documentation of 'psychosis' without querying for specific psychotic features

Confusing with other unspecified induced disorder codes that do not carry the psychosis HCC

Not documenting the basis for the psychosis diagnosis in the clinical record

Common Mistakes

HCC Buddy guidance

F15.250 — Use when delusions are specifically documented

F15.251 — Use when hallucinations are specifically documented

F15.29 — Stimulant dependence with unspecified induced disorder; broader unspecified code, not specific to psychosis

F15.959 — Stimulant use, unspecified with psychotic disorder, unspecified; less specific regarding dependence

Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →

Is F15.259 an HCC code?

Yes. F15.259 (Other stimulant dependence with stimulant-induced psychotic disorder, unspecified) maps to Drug Use with Psychotic Complications under the CMS-HCC V28 risk adjustment model (and Substance Use with Psychotic Complications under V24), with a community non-dual aged RAF of 0.424. It is billable for payment year 2026.

Coder answer: F15.259 is billable and maps to V28 HCC 135, Drug Use with Psychotic Complications. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code: F15.259
Description: Other stimulant dependence with stimulant-induced psychotic disorder, unspecified
HCC (V28): HCC 135 — Drug Use with Psychotic Complications
RAF: 0.424
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 135, Drug Use with Psychotic Complications

0.424

V24HCC 54, Substance Use with Psychotic Complications

0.329

ESRDHCC 54, Substance Use with Psychotic Complications

0.111

Each model's RAF is its CMS base weight for that model's standard population, so weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. 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.

Work F15.259 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

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.

Coder workflow notes

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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 Use with Psychotic Complications (HCC 135) with a community, non-dual, aged base RAF weight of 0.424. Under the older CMS-HCC V24 model, F15.259 maps to Substance Use with Psychotic Complications (HCC 54) with a community, non-dual, aged base RAF weight of 0.329. 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

Commonly Confused Codes

•F15.250: Use when delusions are specifically documented
•F15.251: Use when hallucinations are specifically documented
•F15.29: Stimulant dependence with unspecified induced disorder; broader unspecified code, not specific to psychosis
•F15.959: Stimulant use, unspecified with psychotic disorder, unspecified; less specific regarding dependence