What is ICD-10 code F16.11?

F16.11 is the ICD-10-CM diagnosis code for Hallucinogen abuse, in remission. A condition where someone previously abused hallucinogenic drugs but is now in recovery or remission from that abuse. It belongs to the ICD-10-CM chapter for mental, behavioral and neurodevelopmental disorders (f01-f99). F16.11 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. F16.11 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. F16.11 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. F16.11 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.

Which HCC does F16.11 map to under V28?

F16.11 maps to CMS-HCC V28 HCC 138 (Drug Use Disorder, Mild, Uncomplicated, Except Cannabis). The category numbers, labels, and conditions come from the CMS-HCC V28 model file for payment year 2026.

2026 ICD-10-CM F16.11: Hallucinogen abuse

F16.11 maps to CMS-HCC V28 138. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · free HCC coding tools

ICD-10-CM Code View

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Code lookupF16.11

Effective 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)

F16.11

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

Hallucinogen abuse, in remission

A condition where someone previously abused hallucinogenic drugs but is now in recovery or remission from that abuse.

Buddy Insight

Hallucinogen abuse in remission indicates a patient who previously met criteria for hallucinogen abuse but has achieved recovery status.

Overview Risk Models Code Book Documentation Audit Notes Edition comparison

CMS-HCC V28

Mapped

HCC 138

Drug Use Disorder, Mild, Unco...

Code-level coefficient reference

CMS-HCC V24

Historical

Not used for standard CY2026 Medicare Advantage payment. Select a historical period to review V24.

Not used for CY2026 payment

ACA/HHS

N/A

—

Not risk-adjusted for this model/period.

Not mapped

ESRD/PACE

Mapped

HCC 56

Substance Use Disorder/Mild/E...

Code-level coefficient reference

RXHCC

N/A

—

Not risk-adjusted for this model/period.

Not mapped

Code Book Path

Official

F16Hallucinogen related disorders F16.1Hallucinogen abuse F16.11Hallucinogen abuse, in remission

Inclusion Terms

Official

Other hallucinogen use disorder, mild, in early remission
Other hallucinogen use disorder, mild, in sustained remission
Phencyclidine use disorder, mild, in early remission
Phencyclidine use disorder, mild, in sustained remission

Excludes 2

Official

symptoms, signs and abnormal clinical laboratory findings, not elsewhere classified (R00-R99)Inherited from F01-F99

Related Codes

Official

F16.10Hallucinogen abuse, uncomplicated F16.12Hallucinogen abuse with intoxication F16.14Hallucinogen abuse with hallucinogen-induced mood disorder F16.15Hallucinogen abuse with hallucinogen-induced psychotic disorder F16.18Hallucinogen abuse with other hallucinogen-induced disorder

Includes

Official

disorders of psychological developmentInherited from F01-F99, F16
ecstasyInherited from F01-F99, F16
PCPInherited from F01-F99, F16
phencyclidineInherited from F01-F99, F16

Excludes 1

Official

hallucinogen dependence (F16.2-)Inherited from F16.1
hallucinogen use, unspecified (F16.9-)Inherited from F16.1

Code First

Official

No Code First sequencing instructions are included in this display for F16.11. Check the code and parent instructions in the Code Book.

Use Additional

Official

No Use Additional Code instructions are included in this display for F16.11. Check the code and parent instructions in the Code Book.

Code Also

Official

No Code Also instructions are included in this display for F16.11. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance

History of hallucinogen abuse documented

Provider explicitly documents remission status (early remission, sustained remission)

Duration of remission documented when available

Assessment for persistent perceptual symptoms or psychiatric sequelae

MEAT Support

HCC Buddy guidance

History of hallucinogen abuse documented

Provider explicitly documents remission status (early remission, sustained remission)

Duration of remission documented when available

Assessment for persistent perceptual symptoms or psychiatric sequelae

Audit Caution

HCC Buddy guidance

Coding active abuse when the patient is documented as being in remission

Not coding remission at all, missing the risk adjustment value

Assuming 'not currently using' equals remission without explicit provider documentation

Confusing historical hallucinogen use with remission from a documented abuse diagnosis

Common Mistakes

HCC Buddy guidance

F16.10 — Hallucinogen abuse, uncomplicated; active abuse, not in remission

F16.21 — Hallucinogen dependence, in remission; more severe prior condition

Z87.898 — Personal history of other specified conditions; not appropriate for active remission

F16.183 — Hallucinogen abuse with persisting perception disorder; flashbacks are a separate diagnosis

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 F16.11 an HCC code?

Yes. F16.11 (Hallucinogen abuse, in remission) maps to HCC 138, Drug Use Disorder, Mild, Uncomplicated, Except Cannabis under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.423. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.

Coder answer: F16.11 is billable and maps to V28 HCC 138, Drug Use Disorder, Mild, Uncomplicated, Except Cannabis. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code: F16.11
Description: Hallucinogen abuse, in remission
HCC (V28): HCC 138 — Drug Use Disorder, Mild, Uncomplicated, Except Cannabis
RAF reference coefficient: 0.423
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 138, Drug Use Disorder, Mild, Uncomplicated, Except Cannabis

0.423

ESRDHCC 56, Substance Use Disorder/Mild/Except Alcohol and Cannabis

Not separately weighted

These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. 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 context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.

Work F16.11 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for F16.11

For F16.11, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.

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

Coder workflow notes

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What This Code Means

F16.11 is the ICD-10-CM diagnosis code for hallucinogen abuse, in remission. A condition where someone previously abused hallucinogenic drugs but is now in recovery or remission from that abuse. F16.11 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, F16.11 maps to Drug Use Disorder, Mild, Uncomplicated, Except Cannabis (HCC 138) with a source-labeled community, non-dual, aged reference coefficient of 0.423. No V24 mapping is shown for F16.11; use the applicable model and payment year when reviewing the V28 mapping. For CY2026 non-PACE Medicare Advantage, CMS uses 100% of the 2024 CMS-HCC model (V28). PACE uses a separate model blend. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.

Use this code when the patient has achieved sustained abstinence or controlled use. For F16.11, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule. 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, source-labeled coefficient references, and MEAT documentation criteria for F16.11 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Use this code when the patient has achieved sustained abstinence or controlled use
•Document the length of remission and any ongoing treatment or support services

Clinical Significance

Hallucinogen abuse in remission indicates a patient who previously met criteria for hallucinogen abuse but has achieved recovery status. Despite remission, these patients remain at risk for relapse and may experience long-term psychiatric effects including hallucinogen persisting perception disorder (flashbacks). Continued monitoring and documentation of remission status supports ongoing risk adjustment and clinical surveillance.

Documentation Requirements

✓History of hallucinogen abuse documented
✓Provider explicitly documents remission status (early remission, sustained remission)
✓Duration of remission documented when available
✓Assessment for persistent perceptual symptoms or psychiatric sequelae
✓Ongoing monitoring plan or discharge from substance use treatment

Commonly Confused Codes

•F16.10: Hallucinogen abuse, uncomplicated; active abuse, not in remission
•F16.21: Hallucinogen dependence, in remission; more severe prior condition
•Z87.898: Personal history of other specified conditions; not appropriate for active remission
•F16.183: Hallucinogen abuse with persisting perception disorder; flashbacks are a separate diagnosis