What is ICD-10 code F16.950?

F16.950 is the ICD-10-CM diagnosis code for Hallucinogen use, unspecified with hallucinogen-induced psychotic disorder with delusions. It belongs to the ICD-10-CM chapter for mental, behavioral and neurodevelopmental disorders (f01-f99). F16.950 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. F16.950 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. F16.950 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. F16.950 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

What is the V28 vs V24 difference for F16.950?

CMS phased in the V28 risk adjustment model over payment years 2024 (33%), 2025 (67%), and 2026 (100%), replacing V24. V28 consolidates HCC categories, removes some lower-acuity conditions, and recalibrates RAF weights across the entire model. For F16.950, V28 maps to Drug/Alcohol Psychosis at RAF 0.000 while V24 mapped to Drug/Alcohol Psychosis at RAF 0.434. Both models can still appear in legacy data and in payer-specific lookback periods.

What should coders know when reporting F16.950?

Verify documentation clearly links the psychotic symptoms with delusions to hallucinogen use rather than a primary psychotic disorder; if the psychosis predates drug use, a different code may be appropriate Confirm the specific hallucinogen type is not documented; if it is specified (e.g., LSD, psilocybin), use the more specific F16.1xx or F16.2xx codes instead of the 'unspecified' category Because F16.950 maps to a payment HCC, the documentation must also satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's risk adjustment score.

F16.950 ICD-10 Code: Hallucinogen use, unspecified

ICD-10-CM Code View

HCC Buddy Code Card

Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.

Code lookupF16.950Effective 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)

F16.950

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

Hallucinogen use, unspecified with hallucinogen-induced psychotic disorder with delusions

This code describes a patient who uses hallucinogenic drugs (such as LSD or psilocybin) and has developed a psychotic disorder characterized by false beliefs (delusions) as a direct result of the drug use. The 'unspecified' portion indicates the pattern or frequency of hallucinogen use is not documented.

Buddy Insight

Hallucinogen use (unspecified) with induced psychotic disorder with delusions represents a serious psychiatric complication where hallucinogen use has triggered false fixed beliefs.

CMS-HCC V28

Mapped

HCC 135

Drug/Alcohol Psychosis

RAF 0.0

CMS-HCC V24

Mapped

HCC 54

Drug/Alcohol Psychosis

RAF 0.434

ACA/HHS

Not risk-adjusted for this model/period.

RAF 0

ESRD/PACE

Mapped

HCC 54

Drug/Alcohol Psychosis

RAF 0.0

RXHCC

Not risk-adjusted for this model/period.

RAF 0

Code Trumping

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Code Book Path

Official

F16.9Hallucinogen use, unspecified

F16.95Hallucinogen use, unspecified with hallucinogen-induced psychotic disorder

F16.950Hallucinogen use, unspecified with hallucinogen-induced psychotic disorder with delusions

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for F16.950 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for F16.950 in this effective period.

Related Child Codes

Official

F16.951Hallucinogen use, unspecified with hallucinogen-induced psychotic disorder with hallucinations

F16.959Hallucinogen use, unspecified with hallucinogen-induced psychotic disorder, unspecified

Includes

Official

ICD-10-CM does not list Includes notes for F16.950 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for F16.950 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for F16.950 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for F16.950 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for F16.950 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Documentation of hallucinogen use (pattern unspecified)

Specific documentation of delusions (types and content of false beliefs)

Provider statement linking psychotic symptoms to hallucinogen use

Mental status examination with psychosis findings

MEAT Support

HCC Buddy guidance

Documentation of hallucinogen use (pattern unspecified)

Specific documentation of delusions (types and content of false beliefs)

Provider statement linking psychotic symptoms to hallucinogen use

Mental status examination with psychosis findings

Audit Caution

HCC Buddy guidance

Missing the psychosis diagnosis, coding only the substance use — this loses the higher HCC 54 value

Coding primary delusional disorder when psychosis is actually substance-induced

Not differentiating delusions from hallucinations in the documentation

Failing to query for abuse vs dependence to achieve a more specific base code

Common Mistakes

HCC Buddy guidance

F16.951 — With hallucinations; use when hallucinations predominate

F16.250 — Hallucinogen dependence with psychotic disorder with delusions; preferred when dependence is documented

F16.150 — Hallucinogen abuse with psychotic disorder with delusions; preferred when abuse is documented

F22 — Delusional disorders; use for primary delusional disorder not substance-induced

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 F16.950 an HCC code?

Yes. F16.950 maps to Drug/Alcohol Psychosis under the CMS-HCC V28 risk adjustment model (and Drug/Alcohol Psychosis under V24).

HCC Category Mapping

V28HCC 135, Drug/Alcohol Psychosis

0.000

V24HCC 54, Drug/Alcohol Psychosis

0.434

ESRDHCC 54, Drug/Alcohol Psychosis

0.000

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 F16.950

For F16.950to 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 F16.950 during that encounter, not just copy-forwarded from a problem list.

What This Code Means

F16.950 is the ICD-10-CM diagnosis code for hallucinogen use, unspecified with hallucinogen-induced psychotic disorder with delusions. This code describes a patient who uses hallucinogenic drugs (such as LSD or psilocybin) and has developed a psychotic disorder characterized by false beliefs (delusions) as a direct result of the drug use. The 'unspecified' portion indicates the pattern or frequency of hallucinogen use is not documented. F16.950 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, F16.950 maps to Drug/Alcohol Psychosis (HCC 135) with a community, non-dual, aged base RAF weight of 0.000. Under the older V24 model, F16.950 mapped to the same category but with a base RAF weight of 0.434, V28 recalibrated weights across the entire model. 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.

Verify documentation clearly links the psychotic symptoms with delusions to hallucinogen use rather than a primary psychotic disorder; if the psychosis predates drug use, a different code may be appropriate. Because F16.950 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 F16.950 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Verify documentation clearly links the psychotic symptoms with delusions to hallucinogen use rather than a primary psychotic disorder; if the psychosis predates drug use, a different code may be appropriate
•Confirm the specific hallucinogen type is not documented; if it is specified (e.g., LSD, psilocybin), use the more specific F16.1xx or F16.2xx codes instead of the 'unspecified' category

Clinical Significance

Hallucinogen use (unspecified) with induced psychotic disorder with delusions represents a serious psychiatric complication where hallucinogen use has triggered false fixed beliefs. Even with unspecified use pattern, this maps to the higher-weighted psychosis HCC, making accurate capture particularly important for risk adjustment.

Documentation Requirements

✓Documentation of hallucinogen use (pattern unspecified)
✓Specific documentation of delusions (types and content of false beliefs)
✓Provider statement linking psychotic symptoms to hallucinogen use
✓Mental status examination with psychosis findings
✓Differentiation from primary psychotic disorders
✓Provider query to clarify abuse vs dependence if possible

Commonly Confused Codes

•F16.951 — With hallucinations; use when hallucinations predominate
•F16.250 — Hallucinogen dependence with psychotic disorder with delusions; preferred when dependence is documented
•F16.150 — Hallucinogen abuse with psychotic disorder with delusions; preferred when abuse is documented
•F22 — Delusional disorders; use for primary delusional disorder not substance-induced