F19.120
BillableOther psychoactive substance abuse with intoxication, uncomplicated
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F19.120 an HCC code?
Yes. F19.120 maps to Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications under the CMS-HCC V28 risk adjustment model (and Substance Use Disorder, Moderate/Severe, or Substance Use with Complications 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 F19.120
For F19.120to 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 F19.120 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F19.120 is the ICD-10-CM diagnosis code for other psychoactive substance abuse with intoxication, uncomplicated. A person who abuses various psychoactive substances and is currently intoxicated without severe complications like delirium or hallucinations. F19.120 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, F19.120 maps to Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications (HCC 137) with a community, non-dual, aged base RAF weight of 0.424. Under the older CMS-HCC V24 model, F19.120 maps to Substance Use Disorder, Moderate/Severe, or Substance Use with Complications (HCC 55) with a community, non-dual, aged base RAF weight of 0.329. 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.
Distinguish between uncomplicated intoxication and intoxication with delirium or perceptual disturbances. Because F19.120 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 F19.120 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Distinguish between uncomplicated intoxication and intoxication with delirium or perceptual disturbances
- •Document the substance(s) involved and current intoxication level when possible
Clinical Significance
This code identifies uncomplicated other psychoactive substance intoxication with abuse, indicating acute substance effects without severe neuropsychiatric complications. While representing a less severe presentation than intoxication with delirium or perceptual disturbances, it still reflects active substance use requiring clinical evaluation. Accurate capture supports risk adjustment for 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
- ✓Documentation of acute intoxication state with signs and symptoms present at the time of encounter
- ✓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
- •F19.121 (Intoxication delirium) — requires documented delirium symptoms beyond simple intoxication
- •F19.122 (Intoxication with perceptual disturbance) — requires documented hallucinations or sensory distortions
- •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