F19.10 ICD-10-CM Code: Other psychoactive substance abuse, uncomplicated
F19.10 maps to CMS-HCC V28 138. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · HCC coding software
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FY 2026 Apr update / Mental, Behavioral and Neurodevelopmental disorders (F01-F99) / Mental and behavioral disorders due to psychoactive substance use (F10-F19)
F19.10
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceOther psychoactive substance abuse, uncomplicated
A person who abuses various psychoactive substances (drugs other than alcohol, tobacco, cannabis, cocaine, or hallucinogens) without current complications.
Buddy Insight
This code identifies uncomplicated other psychoactive substance abuse without current complications, intoxication, or withdrawal.
CMS-HCC V28
MappedHCC 138
Coefficient HCC 138: 0.423 (Community Non-Dual Aged (CNA))
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
N/A—
Not mapped
ESRD/PACE
MappedHCC 56
Code-level coefficient reference
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
Official- Other (or unknown) substance use disorder, mild
Excludes 2
Official- symptoms, signs and abnormal clinical laboratory findings, not elsewhere classified (R00-R99)Inherited from F01-F99
Related Codes
Includes
Official- disorders of psychological developmentInherited from F01-F99, F19
- polysubstance drug use (indiscriminate drug use)Inherited from F01-F99, F19
Excludes 1
Official- other psychoactive substance dependence (F19.2-)Inherited from F19.1
- other psychoactive substance use, unspecified (F19.9-)Inherited from F19.1
Code First
OfficialNo Code First sequencing instructions are included in this display for F19.10. Check the code and parent instructions in the Code Book.
Use Additional
OfficialNo Use Additional Code instructions are included in this display for F19.10. Check the code and parent instructions in the Code Book.
Code Also
OfficialNo Code Also instructions are included in this display for F19.10. Check the code and parent instructions in the Code Book.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
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 F19.10 an HCC code?
Yes. F19.10 (Other psychoactive substance abuse, uncomplicated) maps to HCC 138, Drug Use Disorder, Mild, Uncomplicated, Except Cannabis under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.423. 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: F19.10 is billable and maps to V28 HCC 138, Drug Use Disorder, Mild, Uncomplicated, Except Cannabis. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.
- Code
- F19.10
- Description
- Other psychoactive substance abuse, uncomplicated
- HCC (V28)
- HCC 138 — Drug Use Disorder, Mild, Uncomplicated, Except Cannabis
- RAF reference coefficient
- 0.423
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
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 F19.10 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for F19.10
For F19.10, 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
F19.10 is the ICD-10-CM diagnosis code for other psychoactive substance abuse, uncomplicated. A person who abuses various psychoactive substances (drugs other than alcohol, tobacco, cannabis, cocaine, or hallucinogens) without current complications. F19.10 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, F19.10 maps to Drug Use Disorder, Mild, Uncomplicated, Except Cannabis (HCC 138) with a source-labeled community, non-dual, aged reference coefficient of 0.423. 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.
This code applies to abuse (not dependence) of multiple or unspecified psychoactive substances. For F19.10, 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 F19.10 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This code applies to abuse (not dependence) of multiple or unspecified psychoactive substances
- •Verify that the patient meets criteria for abuse rather than dependence
Clinical Significance
This code identifies uncomplicated other psychoactive substance abuse without current complications, intoxication, or withdrawal. While representing the baseline severity of the substance use disorder, it captures an ongoing condition requiring monitoring, counseling, and treatment planning. Accurate documentation supports risk adjustment for the elevated healthcare needs associated with active substance use disorders.
Documentation Requirements
- ✓Provider documentation specifying the psychoactive substance(s) involved (e.g., designer drugs, bath salts, kratom, polysubstance use)
- ✓Clinical documentation supporting substance abuse pattern (maladaptive use pattern causing clinically significant impairment) without meeting criteria for dependence
- ✓Assessment and plan addressing the substance use disorder with treatment approach documented
Commonly Confused Codes
- •F19.20-F19.29 (Other psychoactive substance dependence): dependence indicates a more severe pattern with tolerance, compulsive use, or withdrawal; abuse is a less severe use pattern
- •F19.90-F19.99 (Other psychoactive substance use, unspecified): unspecified use is used when abuse vs. dependence is not documented
- •F19.11 (In remission): remission indicates the patient has stopped using; uncomplicated indicates active use without current complications
- •F10-F16 (Specific substance codes: alcohol, opioids, cannabis, sedatives, cocaine, stimulants): use substance-specific codes when the substance is identified; F19 is for 'other' or multiple unspecified substances