F16.283
BillableHallucinogen dependence 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 F16.283 an HCC code?
Yes. F16.283 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 F16.283
For F16.283 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 F16.283 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F16.283 is the ICD-10-CM diagnosis code for hallucinogen dependence with hallucinogen persisting perception disorder (flashbacks). A person dependent on hallucinogenic drugs is experiencing flashbacks or persistent perceptual disturbances (spontaneous recurrence of hallucinogenic effects without taking the drug again). F16.283 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, F16.283 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, F16.283 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.
Hallucinogen persisting perception disorder (HPPD) can occur long after hallucinogen use; document the timeline of symptom onset. Because F16.283 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 F16.283 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) can occur long after hallucinogen use; document the timeline of symptom onset
- •This condition is unique to hallucinogens and distinguishes it from other substance-induced disorders
Clinical Significance
Hallucinogen persisting perception disorder (HPPD) with dependence is a unique condition where patients experience spontaneous recurrences of hallucinogenic perceptual disturbances (flashbacks) long after cessation. This is distinct from active psychosis and can be chronic, causing significant functional impairment and psychological distress.
Documentation Requirements
- ✓Documentation of hallucinogen dependence (current or past)
- ✓Description of persisting perceptual disturbances (visual trails, halos, geometric patterns, intensified colors)
- ✓Statement that symptoms occur WITHOUT current hallucinogen use
- ✓Duration and frequency of flashback episodes
- ✓Functional impact of symptoms on daily life
- ✓Differentiation from active psychosis or intoxication
- ✓Neurological examination ruling out other causes of visual disturbances