F16.122
BillableHallucinogen abuse with intoxication with perceptual disturbance
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F16.122 an HCC code?
Yes. F16.122 maps to Drug Use Disorder/Substance Use Disorder, Moderate/Severe under the CMS-HCC V28 risk adjustment model (and Drug/Alcohol Dependence 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 F16.122
For F16.122 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 F16.122 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F16.122 is the ICD-10-CM diagnosis code for hallucinogen abuse with intoxication with perceptual disturbance. Misuse of hallucinogenic drugs with altered sensory perception (such as seeing or hearing things that aren't there) during intoxication. F16.122 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, F16.122 maps to Drug Use Disorder/Substance Use Disorder, Moderate/Severe (HCC 137) with a community, non-dual, aged base RAF weight of 0.358. Under the older CMS-HCC V24 model, F16.122 maps to Drug/Alcohol Dependence (HCC 55) with a community, non-dual, aged base RAF weight of 0.334. 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 the specific perceptual disturbances observed (visual, auditory, tactile, etc.) in the medical record. Because F16.122 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 F16.122 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document the specific perceptual disturbances observed (visual, auditory, tactile, etc.) in the medical record
- •This differs from F16.151 as it involves intoxication effects rather than persistent psychotic disorder
Clinical Significance
Hallucinogen abuse with intoxication with perceptual disturbance captures the characteristic presentation of hallucinogenic drug intoxication with altered sensory perception. While perceptual disturbances are expected with hallucinogens, this code specifically captures clinically significant alterations that require medical attention. This is distinct from a persistent psychotic disorder and indicates acute, transient effects.
Documentation Requirements
- ✓Documented hallucinogen abuse
- ✓Evidence of current intoxication
- ✓Specific perceptual disturbances documented: visual distortions, synesthesia, illusions, hallucinations
- ✓Documentation that disturbances are acute intoxication effects, not a persistent psychotic disorder
- ✓Clinical assessment of severity and any interventions for distressing perceptual symptoms
Commonly Confused Codes
- •F16.120 — Hallucinogen abuse with uncomplicated intoxication; use when perceptual disturbances are minimal
- •F16.150/F16.151 — Hallucinogen abuse with psychotic disorder; persistent psychosis, not transient intoxication effects
- •F16.183 — Hallucinogen abuse with persisting perception disorder (flashbacks); occurs AFTER intoxication has resolved
- •F16.121 — Hallucinogen abuse with intoxication delirium; delirium involves broader cognitive impairment