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F16.120 ICD-10-CM Code: Hallucinogen abuse with intoxication, uncomplicated

F16.120 maps to CMS-HCC V28 137. A source-labeled RAF reference is available. Documentation must support MEAT. MEAT criteria · RAF Calculator · HCC Buddy coding tools

ICD-10-CM Code View

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

F16.120

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

Hallucinogen abuse with intoxication, uncomplicated

A condition where someone abuses hallucinogenic drugs and is currently intoxicated or under the influence without additional complications.

Buddy the Bee presenting code insight

Buddy Insight

Hallucinogen abuse with uncomplicated intoxication captures a patient actively under the influence of hallucinogenic drugs without severe complications like delirium.

CMS-HCC V28

HCC 137

Code-level coefficient reference

CMS-HCC V24

Historical

Historical

Not used for CY2026 payment

ACA/HHS

HCC 082

Code-level coefficient reference

ESRD/PACE

HCC 55

Code-level coefficient reference

RXHCC

N/A

—

Not mapped

Code Book Path

Official
F16.1Hallucinogen abuse
F16.12Hallucinogen abuse with intoxication
F16.120Hallucinogen abuse with intoxication, uncomplicated

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for F16.120 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for F16.120 in this effective period.

Related Child Codes

Official
F16.121Hallucinogen abuse with intoxication with delirium
F16.122Hallucinogen abuse with intoxication with perceptual disturbance
F16.129Hallucinogen abuse with intoxication, unspecified

Includes

Official

ICD-10-CM does not list Includes notes for F16.120 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for F16.120 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for F16.120 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for F16.120 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for F16.120 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance
Documented hallucinogen abuse pattern
Clinical evidence of current intoxication: perceptual changes, pupil dilation, tachycardia, diaphoresis
Absence of delirium or severe perceptual disturbances warranting a higher-specificity code
Time of last substance use documented when available

MEAT Support

HCC Buddy guidance
Documented hallucinogen abuse pattern
Clinical evidence of current intoxication: perceptual changes, pupil dilation, tachycardia, diaphoresis
Absence of delirium or severe perceptual disturbances warranting a higher-specificity code
Time of last substance use documented when available

Audit Caution

HCC Buddy guidance
Coding uncomplicated intoxication when the patient has significant perceptual disturbances or delirium
Not documenting intoxication signs when the patient is clearly under the influence
Confusing normal hallucinogenic effects with uncomplicated intoxication — most hallucinogen intoxication involves some perceptual changes
Using dependence codes when only abuse criteria are supported

Common Mistakes

HCC Buddy guidance
F16.121 — Hallucinogen abuse with intoxication with delirium; use when delirium is present
F16.122 — Hallucinogen abuse with intoxication with perceptual disturbance; use when significant perceptual changes occur
F16.10 — Hallucinogen abuse, uncomplicated; use when NOT currently intoxicated
F16.220 — Hallucinogen dependence with intoxication; requires documented 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 F16.120 an HCC code?

Yes. F16.120 (Hallucinogen abuse with intoxication, uncomplicated) maps to HCC 137, Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.424. 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: F16.120 is billable and maps to V28 HCC 137, Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code
F16.120
Description
Hallucinogen abuse with intoxication, uncomplicated
HCC (V28)
HCC 137 — Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications
RAF reference coefficient
0.424
Billable
Yes
Payment year
2026

HCC Category Mapping

V28HCC 137, Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications
0.424
ESRDHCC 55, Substance Use Disorder/Moderate/Severe/Substance Use with Complications
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 F16.120 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT Criteria for F16.120

For F16.120 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 F16.120 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

F16.120 is the ICD-10-CM diagnosis code for hallucinogen abuse with intoxication, uncomplicated. A condition where someone abuses hallucinogenic drugs and is currently intoxicated or under the influence without additional complications. F16.120 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, F16.120 maps to Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications (HCC 137) with a source-labeled community, non-dual, aged reference coefficient of 0.424. No V24 mapping is shown for F16.120; use the applicable model and payment year when reviewing the V28 mapping. 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. 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.

This code indicates active intoxication; assess for safety risks and need for immediate intervention. Because F16.120 maps to an HCC category, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) before the diagnosis is used for risk adjustment. 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 F16.120 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

  • •This code indicates active intoxication; assess for safety risks and need for immediate intervention
  • •Document the time of last use and observed intoxication symptoms

Clinical Significance

Hallucinogen abuse with uncomplicated intoxication captures a patient actively under the influence of hallucinogenic drugs without severe complications like delirium. Hallucinogen intoxication can present with perceptual intensification, depersonalization, derealization, and autonomic changes. This code is commonly used in emergency settings where patients present with acute hallucinogenic effects.

Documentation Requirements

  • ✓Documented hallucinogen abuse pattern
  • ✓Clinical evidence of current intoxication: perceptual changes, pupil dilation, tachycardia, diaphoresis
  • ✓Absence of delirium or severe perceptual disturbances warranting a higher-specificity code
  • ✓Time of last substance use documented when available
  • ✓Safety assessment and any interventions provided

Commonly Confused Codes

  • •F16.121: Hallucinogen abuse with intoxication with delirium; use when delirium is present
  • •F16.122: Hallucinogen abuse with intoxication with perceptual disturbance; use when significant perceptual changes occur
  • •F16.10: Hallucinogen abuse, uncomplicated; use when NOT currently intoxicated
  • •F16.220: Hallucinogen dependence with intoxication; requires documented dependence

Child Codes

F16.120Hallucinogen abuse with intoxication, uncomplicated
HCC 137
F16.121Hallucinogen abuse with intoxication with delirium
HCC 137
F16.122Hallucinogen abuse with intoxication with perceptual disturbance
HCC 137
F16.129Hallucinogen abuse with intoxication, unspecified
HCC 137

Code Hierarchy

└F16Hallucinogen related disorders└F16.1Hallucinogen abuse└F16.12Hallucinogen abuse with intoxication└F16.120Hallucinogen abuse with intoxication, uncomplicated
└F16.120Hallucinogen abuse with intoxication, uncomplicated

Because F16.120 maps to an HCC category, the documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) before the diagnosis is used for risk adjustment.

F16.120 maps to CMS-HCC V28 category 137, Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications. See the ICD-10 to HCC mapping hub for how the V28 crosswalk works. The mapping identifies a payment HCC category for F16.120. Review its source-labeled HCC coefficient above, check the RAF Calculator with complete member context for CMS-HCC V28 PY2026, and confirm the documentation the chart needs before the code is submitted. HCC Buddy shows no RAF score unless every required source and calculation check passes.

Work F16.120 in HCC Buddy

Open F16.120 in the Code Book for the full Index-to-Tabular path, MEAT checklist, and V28 HCC mapping, or in the Encoder to code from a keyword search. Pro includes 7 days to try everything, no card required.

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