F16.280 ICD-10-CM Code: Hallucinogen dependence with hallucinogen-induced anxiety disorder
HCC Buddy Code Card
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FY 2026 Apr update / Mental, Behavioral and Neurodevelopmental disorders (F01-F99) / Mental and behavioral disorders due to psychoactive substance use (F10-F19)
F16.280
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceHallucinogen dependence with hallucinogen-induced anxiety disorder
A person dependent on hallucinogenic drugs is experiencing anxiety disorder that is caused by the hallucinogen use.
Buddy Insight
Hallucinogen dependence with induced anxiety disorder reflects a dual condition where chronic hallucinogen use has triggered clinically significant anxiety.
CMS-HCC V28
MappedHCC 137
RAF 0.358
CMS-HCC V24
MappedHCC 55
RAF 0.334
ACA/HHS
00
RAF 0
ESRD/PACE
MappedHCC 55
RAF 0.0
RXHCC
00
RAF 0
Code Trumping
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Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for F16.280 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for F16.280 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for F16.280 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for F16.280 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for F16.280 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for F16.280 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for F16.280 in this effective period.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.
Is F16.280 an HCC code?
Yes. F16.280 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 F16.280
For F16.280to 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 F16.280 during that encounter, not just copy-forwarded from a problem list.
What This Code Means
F16.280 is the ICD-10-CM diagnosis code for hallucinogen dependence with hallucinogen-induced anxiety disorder. A person dependent on hallucinogenic drugs is experiencing anxiety disorder that is caused by the hallucinogen use. F16.280 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, F16.280 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, F16.280 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 the anxiety is directly induced by hallucinogen dependence, not a separate anxiety disorder. Because F16.280 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 F16.280 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This code indicates the anxiety is directly induced by hallucinogen dependence, not a separate anxiety disorder
- •Document the severity and specific anxiety symptoms (panic, generalized anxiety, social anxiety) if available
Clinical Significance
Hallucinogen dependence with induced anxiety disorder reflects a dual condition where chronic hallucinogen use has triggered clinically significant anxiety. This may manifest as panic attacks, generalized anxiety, or phobic symptoms directly attributable to hallucinogen exposure, requiring both addiction and psychiatric treatment.
Documentation Requirements
- ✓Documentation of hallucinogen dependence
- ✓Specific anxiety symptoms documented (panic, generalized anxiety, social anxiety, phobic features)
- ✓Provider statement that anxiety is induced by hallucinogen use, not a primary anxiety disorder
- ✓Temporal relationship between hallucinogen use and anxiety onset
- ✓Assessment ruling out other causes of anxiety
- ✓Treatment plan addressing both dependence and anxiety
Commonly Confused Codes
- •F16.180 — Hallucinogen abuse with induced anxiety disorder; use when abuse rather than dependence
- •F16.980 — Hallucinogen use, unspecified with induced anxiety; less specific regarding use pattern
- •F41.1 — Generalized anxiety disorder; use for primary anxiety NOT induced by substance use
- •F16.24 — Hallucinogen dependence with induced mood disorder; mood and anxiety disorders are distinct categories