F16.94
BillableHallucinogen use, unspecified with hallucinogen-induced mood disorder
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F16.94 an HCC code?
Yes. F16.94 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 F16.94
For F16.94 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 F16.94 during that encounter — not just copy-forwarded from a problem list.
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/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, F16.94 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.
Document the specific mood disorder (depression, mania, etc.) in the clinical record. Because F16.94 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 F16.94 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