F16.151
BillableHallucinogen abuse with hallucinogen-induced psychotic disorder with hallucinations
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F16.151 an HCC code?
Yes. F16.151 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 F16.151
For F16.151 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 F16.151 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F16.151 is the ICD-10-CM diagnosis code for hallucinogen abuse with hallucinogen-induced psychotic disorder with hallucinations. Misuse of hallucinogenic drugs leading to a persistent psychotic disorder characterized by false perceptions or sensations (hallucinations). F16.151 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, F16.151 maps to Drug/Alcohol Psychosis (HCC 135) with a community, non-dual, aged base RAF weight of 0.000. Under the older V24 model, F16.151 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.
Distinguish between acute intoxication-related hallucinations (F16.122) and persistent psychotic hallucinations. Because F16.151 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 F16.151 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Distinguish between acute intoxication-related hallucinations (F16.122) and persistent psychotic hallucinations
- •Document the duration and persistence of hallucinations beyond the expected intoxication period
Clinical Significance
Hallucinogen abuse with hallucinogen-induced psychotic disorder with hallucinations represents a severe complication where persistent hallucinations develop beyond the expected duration of hallucinogenic drug effects. While hallucinations during intoxication are expected with hallucinogens, this code captures cases where hallucinations persist and constitute a true psychotic disorder requiring psychiatric intervention. This carries the highest risk adjustment weight in the substance use hierarchy.
Documentation Requirements
- ✓Documented hallucinogen abuse pattern
- ✓Hallucinations described with type (visual, auditory, tactile) that persist beyond acute intoxication
- ✓Documentation distinguishing persistent psychotic hallucinations from expected intoxication effects
- ✓Temporal relationship between hallucinogen use and onset of persistent hallucinations
- ✓Psychiatric evaluation and treatment plan for psychotic symptoms
Commonly Confused Codes
- •F16.122 — Hallucinogen abuse with intoxication with perceptual disturbance; transient effects during intoxication only
- •F16.183 — Hallucinogen persisting perception disorder (flashbacks); recurrent brief perceptual experiences, not persistent psychosis
- •F16.150 — Hallucinogen abuse with psychotic disorder with delusions; delusions vs. hallucinations
- •F20.9 — Schizophrenia, unspecified; primary psychotic disorder