F16.220
BillableHallucinogen dependence with intoxication, uncomplicated
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F16.220 an HCC code?
Yes. F16.220 maps to Drug Use Disorder/Substance Use Disorder, Moderate/Severe under the CMS-HCC V28 risk adjustment model (and Drug/Alcohol Dependence 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 F16.220
For F16.220 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 F16.220 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F16.220 is the ICD-10-CM diagnosis code for hallucinogen dependence with intoxication, uncomplicated. A person dependent on hallucinogenic drugs is currently intoxicated from using them, without severe complications like confusion or delirium. F16.220 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, F16.220 maps to Drug Use Disorder/Substance Use Disorder, Moderate/Severe (HCC 137) with a community, non-dual, aged base RAF weight of 0.358. Under the older CMS-HCC V24 model, F16.220 maps to Drug/Alcohol Dependence (HCC 55) with a community, non-dual, aged base RAF weight of 0.334. 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 active intoxication without delirium; if delirium is present, use F16.221 instead. Because F16.220 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 F16.220 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This code indicates active intoxication without delirium; if delirium is present, use F16.221 instead
- •Document the timing and amount of hallucinogen use to support the intoxication diagnosis
Clinical Significance
This code captures hallucinogen dependence with active uncomplicated intoxication, indicating the patient is under the immediate effects of hallucinogens. This represents an acute clinical situation requiring monitoring and potentially emergency medical intervention, with significant implications for patient safety.
Documentation Requirements
- ✓Documentation of established hallucinogen dependence
- ✓Clinical signs of current intoxication (perceptual changes, tachycardia, pupil dilation, agitation)
- ✓Statement that intoxication is uncomplicated — no delirium, seizures, or other severe manifestations
- ✓Vital signs and mental status examination
- ✓Specific hallucinogen identified when possible
Commonly Confused Codes
- •F16.221 — Hallucinogen dependence with intoxication with delirium; use when delirium is present
- •F16.229 — Hallucinogen dependence with intoxication, unspecified; use only when delirium status cannot be determined
- •F16.120 — Hallucinogen abuse with intoxication, uncomplicated; use when abuse rather than dependence is documented
- •F16.920 — Hallucinogen use, unspecified with intoxication; use when abuse vs dependence is undetermined