F16.988 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

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 lookupF16.988

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)

F16.988

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

Hallucinogen use, unspecified with other hallucinogen-induced disorder

A condition where someone uses hallucinogenic drugs (like LSD or psilocybin) and experiences other drug-related health problems as a result, but the specific type of hallucinogen is not identified.

Buddy Insight

This code captures other specified hallucinogen-induced disorders in patients with unspecified hallucinogen use pattern, covering conditions like substance-induced sleep disorders, sexual dysfunction, or other neurocognitive effects not classified under mood, anxiety, psychosis, or HPPD categories.

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

F16.9Hallucinogen use, unspecified F16.98Hallucinogen use, unspecified with other specified hallucinogen-induced disorder F16.988Hallucinogen use, unspecified with other hallucinogen-induced disorder

Inclusion Terms

Official

No inclusion terms are included in this display for F16.988. Check the code and parent instructions in the Code Book.

Excludes 2

Official

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

Related Codes

Official

F16.980Hallucinogen use, unspecified with hallucinogen-induced anxiety disorder F16.983Hallucinogen use, unspecified with hallucinogen persisting perception disorder (flashbacks)

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 F16.988. Check the code and parent instructions in the Code Book.

Use Additional

Official

No Use Additional Code instructions are included in this display for F16.988. Check the code and parent instructions in the Code Book.

Code Also

Official

No Code Also instructions are included in this display for F16.988. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance

Documentation of hallucinogen use

Specific identification of the induced disorder

Causal link between hallucinogen use and the condition

Documentation that the disorder does not fit mood, anxiety, psychotic, or HPPD categories

MEAT Support

HCC Buddy guidance

Documentation of hallucinogen use

Specific identification of the induced disorder

Causal link between hallucinogen use and the condition

Documentation that the disorder does not fit mood, anxiety, psychotic, or HPPD categories

Audit Caution

HCC Buddy guidance

Using this code when a more specific induced disorder category exists

Not documenting what the 'other' induced disorder actually is

Confusing 'other specified' with 'unspecified' — they are different concepts

Failing to query for abuse vs dependence pattern

Common Mistakes

HCC Buddy guidance

F16.99 — With unspecified induced disorder; use only when the disorder truly cannot be identified

F16.94 — With induced mood disorder; use when mood symptoms predominate

F16.980 — With induced anxiety disorder; use when anxiety is the primary complication

F16.288 — Hallucinogen dependence with other induced disorder; more specific regarding dependence

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 F16.988 an HCC code?

Yes. F16.988 (Hallucinogen use, unspecified with other hallucinogen-induced 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: F16.988 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: F16.988
Description: Hallucinogen use, unspecified with other hallucinogen-induced 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 F16.988 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for F16.988

For F16.988, 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

Get the V28 mapping + MEAT cheat sheet

One printable reference: check representative V28 mappings and the documentation reminders your note needs. Free, no card.

Free PDF. No card. Unsubscribe anytime.

What This Code Means

F16.988 is the ICD-10-CM diagnosis code for hallucinogen use, unspecified with other hallucinogen-induced disorder. A condition where someone uses hallucinogenic drugs (like LSD or psilocybin) and experiences other drug-related health problems as a result, but the specific type of hallucinogen is not identified. F16.988 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, F16.988 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.

Use this code when hallucinogen use is documented but the specific substance cannot be determined and other induced disorders are present. For F16.988, 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 F16.988 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Use this code when hallucinogen use is documented but the specific substance cannot be determined and other induced disorders are present
•Ensure documentation specifies what hallucinogen-induced disorder is present (e.g., psychosis, mood disorder) for accurate coding

Clinical Significance

Documentation Requirements

✓Documentation of hallucinogen use
✓Specific identification of the induced disorder
✓Causal link between hallucinogen use and the condition
✓Documentation that the disorder does not fit mood, anxiety, psychotic, or HPPD categories
✓Provider query for abuse vs dependence clarification

Commonly Confused Codes

•F16.99: With unspecified induced disorder; use only when the disorder truly cannot be identified
•F16.94: With induced mood disorder; use when mood symptoms predominate
•F16.980: With induced anxiety disorder; use when anxiety is the primary complication
•F16.288: Hallucinogen dependence with other induced disorder; more specific regarding dependence