F16.14
BillableHallucinogen abuse with hallucinogen-induced mood disorder
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F16.14 an HCC code?
Yes. F16.14 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 F16.14
For F16.14 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 F16.14 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F16.14 is the ICD-10-CM diagnosis code for hallucinogen abuse with hallucinogen-induced mood disorder. This code describes a patient who misuses hallucinogenic drugs (such as LSD or psilocybin) and has developed a mood disorder as a direct result of that drug use. The mood disorder may include symptoms like depression, anxiety, or mood swings that are caused by or worsened by the hallucinogen abuse. F16.14 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, F16.14 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, F16.14 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.
Verify that the mood disorder is documented as being induced by or related to hallucinogen use; if the mood disorder is independent, use separate codes for both conditions. Because F16.14 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 F16.14 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify that the mood disorder is documented as being induced by or related to hallucinogen use; if the mood disorder is independent, use separate codes for both conditions
- •Ensure the documentation specifies 'abuse' rather than 'dependence' or 'use' - F16.14 is specifically for abuse; dependence would use F16.24 and uncomplicated use would use F16.94
Clinical Significance
Hallucinogen abuse with hallucinogen-induced mood disorder captures mood disturbances directly caused by hallucinogenic drug use. Hallucinogens can trigger both depressive and manic-like symptoms, and some patients develop prolonged mood episodes after hallucinogen exposure. This dual diagnosis of substance abuse and induced mood disorder increases treatment complexity and healthcare resource utilization.
Documentation Requirements
- ✓Documented hallucinogen abuse pattern
- ✓Clinical description of mood disorder: depression, mania, or mixed features
- ✓Clear documentation that mood symptoms are induced by hallucinogen use, not a pre-existing condition
- ✓Temporal relationship between hallucinogen use and mood symptom onset
- ✓Treatment plan addressing both substance abuse and mood disorder