F19.139
BillableOther psychoactive substance abuse with withdrawal, unspecified
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F19.139 an HCC code?
Yes. F19.139 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 F19.139
For F19.139 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 F19.139 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F19.139 is the ICD-10-CM diagnosis code for other psychoactive substance abuse with withdrawal, unspecified. This code describes a patient who is abusing a psychoactive substance (other than alcohol, opioids, cannabis, stimulants, hallucinogens, or inhalants) and is experiencing withdrawal symptoms, but the specific substance is not identified. Withdrawal occurs when someone stops or reduces use of a substance their body has become dependent on. F19.139 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, F19.139 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, F19.139 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.
Use this code only when the specific psychoactive substance cannot be identified; if the substance is known (such as sedatives, hypnotics, or anxiolytics), use the more specific F13.139 code instead. Because F19.139 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 F19.139 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use this code only when the specific psychoactive substance cannot be identified; if the substance is known (such as sedatives, hypnotics, or anxiolytics), use the more specific F13.139 code instead
- •The '139' component indicates abuse with withdrawal unspecified; verify documentation supports both abuse (not just dependence) and active withdrawal symptoms before coding
Clinical Significance
This code captures other psychoactive substance withdrawal syndrome where the specific complications are not documented. Withdrawal indicates physiological dependence and requires medical management to prevent potentially life-threatening complications. While less specific, this code still captures a clinically significant state that elevates resource needs.
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 withdrawal symptoms temporally related to cessation or reduction of substance use
- ✓Assessment and plan addressing the substance use disorder with treatment approach documented