F16.94 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 coding software

ICD-10-CM Code View

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Code lookupF16.94

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)

F16.94

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

Hallucinogen use, unspecified with hallucinogen-induced mood disorder

A person uses hallucinogenic drugs and develops mood problems such as depression or mania caused by the hallucinogen.

Buddy Insight

Hallucinogen use (unspecified pattern) with induced mood disorder captures patients experiencing depression, mania, or mixed mood features caused by hallucinogen use.

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

F16Hallucinogen related disorders F16.9Hallucinogen use, unspecified F16.94Hallucinogen use, unspecified with hallucinogen-induced mood disorder

Inclusion Terms

Official

Other hallucinogen induced bipolar or related disorder, without use disorder
Other hallucinogen induced depressive disorder, without use disorder
Phencyclidine induced bipolar or related disorder, without use disorder
Phencyclidine induced depressive disorder, without use disorder

Excludes 2

Official

symptoms, signs and abnormal clinical laboratory findings, not elsewhere classified (R00-R99)Inherited from F01-F99

Related Codes

Official

F16.90Hallucinogen use, unspecified, uncomplicated F16.91Hallucinogen use, unspecified, in remission F16.92Hallucinogen use, unspecified with intoxication F16.95Hallucinogen use, unspecified with hallucinogen-induced psychotic disorder F16.98Hallucinogen use, unspecified with other specified 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 abuse (F16.1-)Inherited from F16.9
hallucinogen dependence (F16.2-)Inherited from F16.9

Code First

Official

No Code First sequencing instructions are included in this display for F16.94. Check the code and parent instructions in the Code Book.

Use Additional

Official

No Use Additional Code instructions are included in this display for F16.94. Check the code and parent instructions in the Code Book.

Code Also

Official

No Code Also instructions are included in this display for F16.94. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance

Documentation of hallucinogen use

Specific mood disorder symptoms (depressive, manic, or mixed)

Provider statement that the mood disturbance is induced by hallucinogen use

Query for abuse vs dependence clarification

MEAT Support

HCC Buddy guidance

Documentation of hallucinogen use

Specific mood disorder symptoms (depressive, manic, or mixed)

Provider statement that the mood disturbance is induced by hallucinogen use

Query for abuse vs dependence clarification

Audit Caution

HCC Buddy guidance

Not querying provider to clarify abuse vs dependence

Coding a separate primary mood disorder instead of the substance-induced code

Confusing substance-induced mood disorder with an independent disorder exacerbated by use

Missing documentation supporting a more specific use pattern code

Common Mistakes

HCC Buddy guidance

F16.14 — Hallucinogen abuse with induced mood disorder; preferred when abuse is documented

F16.24 — Hallucinogen dependence with induced mood disorder; preferred when dependence is documented

F32.9 — Major depressive disorder, unspecified; use for primary depression not substance-induced

F16.980 — Hallucinogen use, unspecified with induced anxiety; anxiety is distinct from mood disorder

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 F16.94 an HCC code?

Yes. F16.94 (Hallucinogen use, unspecified with hallucinogen-induced mood disorder) 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: F16.94 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: F16.94
Description: Hallucinogen use, unspecified with hallucinogen-induced mood disorder
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 F16.94 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for F16.94

For F16.94, 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

F16.94 is the ICD-10-CM diagnosis code for hallucinogen use, unspecified with hallucinogen-induced mood disorder. A person uses hallucinogenic drugs and develops mood problems such as depression or mania caused by the hallucinogen. F16.94 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, F16.94 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.

Document the specific mood disorder (depression, mania, etc.) in the clinical record. For F16.94, 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 F16.94 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Document the specific mood disorder (depression, mania, etc.) in the clinical record
•Distinguish between hallucinogen-induced mood disorder and primary mood disorders

Clinical Significance

Hallucinogen use (unspecified pattern) with induced mood disorder captures patients experiencing depression, mania, or mixed mood features caused by hallucinogen use. The unspecified use pattern indicates documentation does not clarify abuse vs dependence, but the mood disorder complication adds clinical complexity.

Documentation Requirements

✓Documentation of hallucinogen use
✓Specific mood disorder symptoms (depressive, manic, or mixed)
✓Provider statement that the mood disturbance is induced by hallucinogen use
✓Query for abuse vs dependence clarification
✓Differentiation from primary mood disorders
✓Treatment plan addressing substance use and mood symptoms

Commonly Confused Codes

•F16.14: Hallucinogen abuse with induced mood disorder; preferred when abuse is documented
•F16.24: Hallucinogen dependence with induced mood disorder; preferred when dependence is documented
•F32.9: Major depressive disorder, unspecified; use for primary depression not substance-induced
•F16.980: Hallucinogen use, unspecified with induced anxiety; anxiety is distinct from mood disorder