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F16.251 ICD-10-CM Code: Hallucinogen dependence with hallucinogen-induced psychotic disorder with hallucinations

F16.251 maps to CMS-HCC V28 135. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · free HCC coding tools

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Code lookupF16.251

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

F16.251

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

Hallucinogen dependence with hallucinogen-induced psychotic disorder with hallucinations

A person dependent on hallucinogenic drugs is experiencing psychosis with hallucinations (seeing or hearing things that aren't real) caused by the hallucinogen use.

Buddy the Bee presenting code insight

Buddy Insight

Hallucinogen dependence with psychotic disorder featuring hallucinations captures active perceptual disturbances (visual, auditory, or tactile) caused by hallucinogen dependence.

OverviewRisk ModelsCode BookDocumentationAuditNotesEdition comparison

CMS-HCC V28

HCC 135

Coefficient HCC 135: 0.424 (Community Non-Dual Aged (CNA))

CMS-HCC V24

Historical

Historical

Not used for CY2026 payment

ACA/HHS

HCC 081

Code-level coefficient reference

ESRD/PACE

HCC 54

Code-level coefficient reference

RXHCC

N/A

—

Not mapped

Code Book Path

Official
F16.2Hallucinogen dependenceF16.25Hallucinogen dependence with hallucinogen-induced psychotic disorderF16.251Hallucinogen dependence with hallucinogen-induced psychotic disorder with hallucinations

Inclusion Terms

Official

No inclusion terms are included in this display for F16.251. 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
F16.250Hallucinogen dependence with hallucinogen-induced psychotic disorder with delusionsF16.259Hallucinogen dependence with hallucinogen-induced psychotic disorder, unspecified

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

Code First

Official

No Code First sequencing instructions are included in this display for F16.251. Check the code and parent instructions in the Code Book.

Use Additional

Official

No Use Additional Code instructions are included in this display for F16.251. Check the code and parent instructions in the Code Book.

Code Also

Official

No Code Also instructions are included in this display for F16.251. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance
Documentation of hallucinogen dependence
Specific documentation of hallucinations (visual, auditory, or other sensory modalities)
Provider statement that hallucinations are induced by hallucinogen use
Mental status examination documenting hallucination type and content

MEAT Support

HCC Buddy guidance
Documentation of hallucinogen dependence
Specific documentation of hallucinations (visual, auditory, or other sensory modalities)
Provider statement that hallucinations are induced by hallucinogen use
Mental status examination documenting hallucination type and content

Audit Caution

HCC Buddy guidance
Confusing HPPD (flashbacks, F16.283) with active psychotic hallucinations — HPPD involves re-experiencing while psychosis involves new perceptual disturbances
Not specifying hallucinations as the psychotic feature when they are clearly documented
Coding both F16.251 and a separate hallucination code — the combination is captured in one code
Missing that psychotic codes map to HCC 54 (higher value) vs HCC 55 for non-psychotic presentations

Common Mistakes

HCC Buddy guidance
F16.250 — Hallucinogen dependence with psychotic disorder with delusions; delusions are false beliefs, not perceptual disturbances
F16.283 — Hallucinogen dependence with persisting perception disorder (flashbacks); flashbacks are re-experiences, not active psychosis
F16.259 — Hallucinogen dependence with psychotic disorder, unspecified; use only when type cannot be determined
F16.151 — Hallucinogen abuse with psychotic disorder with hallucinations; use when abuse not dependence is documented

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 F16.251 an HCC code?

Yes. F16.251 (Hallucinogen dependence with hallucinogen-induced psychotic disorder with hallucinations) maps to HCC 135, Drug Use with 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: F16.251 is billable and maps to V28 HCC 135, Drug Use with Psychotic Complications. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code
F16.251
Description
Hallucinogen dependence with hallucinogen-induced psychotic disorder with hallucinations
HCC (V28)
HCC 135 — Drug Use with Psychotic Complications
RAF reference coefficient
0.424
Billable
Yes
Payment year
2026

HCC Category Mapping

V28HCC 135, Drug Use with Psychotic Complications
0.424
ESRDHCC 54, Substance Use with Psychotic 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 F16.251 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for F16.251

For F16.251, 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

F16.251 is the ICD-10-CM diagnosis code for hallucinogen dependence with hallucinogen-induced psychotic disorder with hallucinations. A person dependent on hallucinogenic drugs is experiencing psychosis with hallucinations (seeing or hearing things that aren't real) caused by the hallucinogen use. F16.251 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, F16.251 maps to Drug Use with Psychotic Complications (HCC 135) with a source-labeled community, non-dual, aged reference coefficient of 0.424. No V24 mapping is shown for F16.251; use the applicable model and payment year when reviewing the V28 mapping. 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.

This code specifies that hallucinations are present; use F16.259 if psychosis is present without specifying hallucinations. For F16.251, 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 F16.251 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

  • •This code specifies that hallucinations are present; use F16.259 if psychosis is present without specifying hallucinations
  • •Document the type of hallucinations (visual, auditory, tactile) and their relationship to hallucinogen use

Clinical Significance

Hallucinogen dependence with psychotic disorder featuring hallucinations captures active perceptual disturbances (visual, auditory, or tactile) caused by hallucinogen dependence. This can persist as hallucinogen persisting psychosis and requires psychiatric evaluation, possible antipsychotic therapy, and safety precautions.

Documentation Requirements

  • ✓Documentation of hallucinogen dependence
  • ✓Specific documentation of hallucinations (visual, auditory, or other sensory modalities)
  • ✓Provider statement that hallucinations are induced by hallucinogen use
  • ✓Mental status examination documenting hallucination type and content
  • ✓Distinction from hallucinogen persisting perception disorder (flashbacks, F16.283) which is a separate condition
  • ✓Assessment of insight — does the patient recognize hallucinations as substance-induced?

Commonly Confused Codes

  • •F16.250: Hallucinogen dependence with psychotic disorder with delusions; delusions are false beliefs, not perceptual disturbances
  • •F16.283: Hallucinogen dependence with persisting perception disorder (flashbacks); flashbacks are re-experiences, not active psychosis
  • •F16.259: Hallucinogen dependence with psychotic disorder, unspecified; use only when type cannot be determined
  • •F16.151: Hallucinogen abuse with psychotic disorder with hallucinations; use when abuse not dependence is documented

Child Codes

F16.250Hallucinogen dependence with hallucinogen-induced psychotic disorder with delusions
HCC 135
F16.251Hallucinogen dependence with hallucinogen-induced psychotic disorder with hallucinations
HCC 135
F16.259Hallucinogen dependence with hallucinogen-induced psychotic disorder, unspecified
HCC 135

Code Hierarchy

└F16Hallucinogen related disorders└F16.2Hallucinogen dependence└F16.25Hallucinogen dependence with hallucinogen-induced psychotic disorder└F16.251Hallucinogen dependence with hallucinogen-induced psychotic disorder with hallucinations
└F16.251Hallucinogen dependence with hallucinogen-induced psychotic disorder with hallucinations

Also searched as

  • F16 251
  • F16251

For F16.251, 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.

F16.251 maps to CMS-HCC V28 category 135, Drug Use with Psychotic Complications. See the ICD-10 to HCC mapping hub for how the V28 crosswalk works. The mapping identifies a payment HCC category for F16.251. Review its source-labeled HCC coefficient above, check the RAF Calculator with complete member context for CMS-HCC V28 PY2026, and confirm the documentation the chart needs before the code is submitted. HCC Buddy shows no RAF score unless every required source and calculation check passes.

Work F16.251 in HCC Buddy

Open F16.251 in the Code Book for the full Index-to-Tabular path, MEAT checklist, and V28 HCC mapping, or in the Encoder to code from a keyword search. Pro includes 7 days to try everything, no card required.

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