F16.183
BillableHallucinogen abuse with hallucinogen persisting perception disorder (flashbacks)
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F16.183 an HCC code?
Yes. F16.183 maps to Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications under the CMS-HCC V28 risk adjustment model (and Substance Use Disorder, Moderate/Severe, or Substance Use with Complications 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 F16.183
For F16.183to 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 F16.183 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F16.183 is the ICD-10-CM diagnosis code for hallucinogen abuse with hallucinogen persisting perception disorder (flashbacks). Misuse of hallucinogenic drugs causing flashbacks or spontaneous recurrence of hallucinogenic experiences long after the drug use. F16.183 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, F16.183 maps to Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications (HCC 137) with a community, non-dual, aged base RAF weight of 0.424. Under the older CMS-HCC V24 model, F16.183 maps to Substance Use Disorder, Moderate/Severe, or Substance Use with Complications (HCC 55) with a community, non-dual, aged base RAF weight of 0.329. 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.
Hallucinogen persisting perception disorder (HPPD) is a specific condition distinct from acute intoxication. Because F16.183 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 F16.183 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Hallucinogen persisting perception disorder (HPPD) is a specific condition distinct from acute intoxication
- •Document the timing and frequency of flashback episodes to support this diagnosis
Clinical Significance
Hallucinogen persisting perception disorder (HPPD), commonly known as 'flashbacks,' is a unique and diagnostically specific condition where perceptual disturbances persist or recur long after hallucinogen use has stopped. Patients experience re-experiencing of perceptual symptoms (trails, halos, geometric patterns, afterimages) in the absence of current drug use. This is a distinct condition from substance-induced psychosis and has its own clinical management approach.
Documentation Requirements
- ✓History of hallucinogen abuse documented
- ✓Specific perceptual disturbances described: visual trailing, halos, afterimages, micropsia/macropsia, geometric patterns, intensified colors
- ✓Documentation that perceptual disturbances occur when NOT intoxicated (key distinguishing feature)
- ✓Duration and frequency of flashback episodes
- ✓Impact on daily functioning and any treatment interventions
- ✓Exclusion of other causes of perceptual disturbances (neurological conditions, other psychiatric disorders)
Commonly Confused Codes
- •F16.122 — Hallucinogen abuse with intoxication with perceptual disturbance; occurs DURING intoxication, not after
- •F16.151 — Hallucinogen abuse with psychotic disorder with hallucinations; persistent psychosis is more severe than HPPD
- •F16.159 — Hallucinogen abuse with unspecified psychotic disorder; HPPD is not classified as a psychotic disorder
- •H53.19 — Subjective visual disturbances, other; primary visual disorder, not substance-related
- •F16.283 — Hallucinogen dependence with persisting perception disorder; requires dependence documentation