F16.180 maps to CMS-HCC V28 137. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · HCC Buddy coding tools

ICD-10-CM Code View

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Code lookupF16.180

Effective periodFY2026 Apr Update (Apr 1-Sep 30)

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

F16.180

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

Hallucinogen abuse with hallucinogen-induced anxiety disorder

Misuse of hallucinogenic drugs causing persistent anxiety disorder as a consequence of the drug use.

Buddy Insight

Hallucinogen abuse with hallucinogen-induced anxiety disorder captures anxiety complications directly caused by hallucinogenic drug use.

Overview Risk Models Code Book Documentation Audit Notes Edition comparison

CMS-HCC V28

Mapped

HCC 137

Drug Use Disorder, Moderate/S...

Coefficient HCC 137: 0.424 (Community Non-Dual Aged (CNA))

CMS-HCC V24

Historical

Not used for standard CY2026 Medicare Advantage payment. Select a historical period to review V24.

Not used for CY2026 payment

ACA/HHS

Mapped

HCC 082

HHS-HCC 082 adult, RAF varies...

Code-level coefficient reference

ESRD/PACE

Mapped

HCC 55

Substance Use Disorder/Modera...

Code-level coefficient reference

RXHCC

N/A

—

Not risk-adjusted for this model/period.

Not mapped

Code Book Path

Official

F16.1Hallucinogen abuse F16.18Hallucinogen abuse with other hallucinogen-induced disorder F16.180Hallucinogen abuse with hallucinogen-induced anxiety disorder

Inclusion Terms

Official

No inclusion terms are included in this display for F16.180. Check the code and parent instructions in the Code Book.

Excludes 2

Official

symptoms, signs and abnormal clinical laboratory findings, not elsewhere classified (R00-R99)Inherited from F01-F99

Related Codes

Official

F16.183Hallucinogen abuse with hallucinogen persisting perception disorder (flashbacks)F16.188Hallucinogen abuse with other hallucinogen-induced disorder

Includes

Official

disorders of psychological developmentInherited from F01-F99, F16
ecstasyInherited from F01-F99, F16
PCPInherited from F01-F99, F16
phencyclidineInherited from F01-F99, F16

Excludes 1

Official

hallucinogen dependence (F16.2-)Inherited from F16.1
hallucinogen use, unspecified (F16.9-)Inherited from F16.1

Code First

Official

No Code First sequencing instructions are included in this display for F16.180. Check the code and parent instructions in the Code Book.

Use Additional

Official

No Use Additional Code instructions are included in this display for F16.180. Check the code and parent instructions in the Code Book.

Code Also

Official

No Code Also instructions are included in this display for F16.180. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance

Documented hallucinogen abuse pattern

Clinical description of anxiety symptoms (panic, generalized anxiety, phobic symptoms)

Causal relationship between hallucinogen use and anxiety onset documented

Documentation that anxiety is substance-induced rather than a pre-existing condition

MEAT Support

HCC Buddy guidance

Documented hallucinogen abuse pattern

Clinical description of anxiety symptoms (panic, generalized anxiety, phobic symptoms)

Causal relationship between hallucinogen use and anxiety onset documented

Documentation that anxiety is substance-induced rather than a pre-existing condition

Audit Caution

HCC Buddy guidance

Coding primary anxiety disorders when anxiety is clearly linked to hallucinogen use

Confusing acute anxiety during a 'bad trip' (part of intoxication) with a persistent induced anxiety disorder

Not establishing the temporal and causal link between hallucinogen use and anxiety

Using uncomplicated abuse codes when anxiety disorder complications are documented

Common Mistakes

HCC Buddy guidance

F16.280 — Hallucinogen dependence with anxiety disorder; requires documented dependence

F16.980 — Hallucinogen use, unspecified with anxiety disorder; less specific regarding use pattern

F41.0 — Panic disorder; primary panic, not substance-induced

F41.1 — Generalized anxiety disorder; primary anxiety, not substance-induced

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 F16.180 an HCC code?

Yes. F16.180 (Hallucinogen abuse with hallucinogen-induced anxiety disorder) 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: F16.180 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: F16.180
Description: Hallucinogen abuse with hallucinogen-induced anxiety disorder
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 F16.180 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for F16.180

For F16.180, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.

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

Coder workflow notes

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What This Code Means

F16.180 is the ICD-10-CM diagnosis code for hallucinogen abuse with hallucinogen-induced anxiety disorder. Misuse of hallucinogenic drugs causing persistent anxiety disorder as a consequence of the drug use. F16.180 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, F16.180 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. For CY2026 non-PACE Medicare Advantage, CMS uses 100% of the 2024 CMS-HCC model (V28). PACE uses a separate model blend. 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.

Document that the anxiety disorder is directly related to hallucinogen abuse, not a pre-existing condition. For F16.180, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule. 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 F16.180 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Document that the anxiety disorder is directly related to hallucinogen abuse, not a pre-existing condition
•This represents a longer-term psychiatric consequence rather than acute intoxication effects

Clinical Significance

Hallucinogen abuse with hallucinogen-induced anxiety disorder captures anxiety complications directly caused by hallucinogenic drug use. Hallucinogens can trigger severe anxiety, panic attacks, and phobic responses, particularly in the context of 'bad trips.' Some patients develop persistent anxiety disorders following hallucinogen exposure that require ongoing treatment beyond the acute episode.

Documentation Requirements

✓Documented hallucinogen abuse pattern
✓Clinical description of anxiety symptoms (panic, generalized anxiety, phobic symptoms)
✓Causal relationship between hallucinogen use and anxiety onset documented
✓Documentation that anxiety is substance-induced rather than a pre-existing condition
✓Treatment plan addressing both the substance abuse and anxiety disorder

Commonly Confused Codes

•F16.280: Hallucinogen dependence with anxiety disorder; requires documented dependence
•F16.980: Hallucinogen use, unspecified with anxiety disorder; less specific regarding use pattern
•F41.0: Panic disorder; primary panic, not substance-induced
•F41.1: Generalized anxiety disorder; primary anxiety, not substance-induced
•F16.120: Hallucinogen abuse with intoxication, uncomplicated; acute intoxication without anxiety disorder