F16.183 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 lookupF16.183

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)

F16.183

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

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.

Buddy Insight

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 F16.183Hallucinogen abuse with hallucinogen persisting perception disorder (flashbacks)

Inclusion Terms

Official

No inclusion terms are included in this display for F16.183. 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

F16.180Hallucinogen abuse with hallucinogen-induced anxiety disorder 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 F16.183. Check the code and parent instructions in the Code Book.

Use Additional

Official

No Use Additional Code instructions are included in this display for F16.183. Check the code and parent instructions in the Code Book.

Code Also

Official

No Code Also instructions are included in this display for F16.183. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance

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

MEAT Support

HCC Buddy guidance

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

Audit Caution

HCC Buddy guidance

Confusing HPPD with ongoing intoxication effects — HPPD occurs in the ABSENCE of current drug use

Coding psychotic disorder (F16.15x) when the presentation is HPPD, which is not a psychotic condition

Not documenting the specific perceptual symptoms characteristic of HPPD

Missing this diagnosis because patients may not spontaneously report flashback experiences

Common Mistakes

HCC Buddy guidance

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

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 F16.183 an HCC code?

Yes. F16.183 (Hallucinogen abuse with hallucinogen persisting perception disorder (flashbacks)) 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: F16.183 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: F16.183
Description: Hallucinogen abuse with hallucinogen persisting perception disorder (flashbacks)
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 F16.183 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for F16.183

For F16.183, 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

F16.183 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 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.

Hallucinogen persisting perception disorder (HPPD) is a specific condition distinct from acute intoxication. For F16.183, 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 F16.183 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