F16.150
BillableHallucinogen abuse with hallucinogen-induced psychotic disorder with delusions
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F16.150 an HCC code?
Yes. F16.150 maps to Drug/Alcohol Psychosis under the CMS-HCC V28 risk adjustment model (and Drug/Alcohol Psychosis 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 F16.150
For F16.150 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 F16.150 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F16.150 is the ICD-10-CM diagnosis code for hallucinogen abuse with hallucinogen-induced psychotic disorder with delusions. Misuse of hallucinogenic drugs leading to a persistent psychotic disorder characterized by false beliefs (delusions). F16.150 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, F16.150 maps to Drug/Alcohol Psychosis (HCC 135) with a community, non-dual, aged base RAF weight of 0.000. Under the older V24 model, F16.150 mapped to the same category but with a base RAF weight of 0.434 — V28 recalibrated weights across the entire model. 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.
This code indicates a more serious psychiatric consequence beyond acute intoxication effects. Because F16.150 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 F16.150 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This code indicates a more serious psychiatric consequence beyond acute intoxication effects
- •Document whether the psychotic symptoms persist after the drug has cleared the system
Clinical Significance
Hallucinogen abuse with hallucinogen-induced psychotic disorder with delusions is a severe psychiatric presentation where hallucinogenic drug abuse triggers persistent delusional beliefs. This is distinct from the expected perceptual changes of hallucinogen intoxication and represents a true psychotic break. Some patients develop persistent psychotic symptoms that outlast the drug's pharmacologic effects, requiring extended psychiatric treatment.
Documentation Requirements
- ✓Documented hallucinogen abuse pattern
- ✓Psychotic symptoms specifically characterized as delusions (fixed false beliefs)
- ✓Temporal and causal relationship between hallucinogen use and delusion onset
- ✓Documentation that delusions persist beyond the expected duration of intoxication or represent true psychotic disorder features
- ✓Psychiatric evaluation ruling out primary psychotic disorders
- ✓Treatment plan for both psychosis and substance abuse