What is ICD-10 code F19.16?

F19.16 is the ICD-10-CM diagnosis code for Other psychoactive substance abuse with psychoactive substance-induced persisting amnestic disorder. A condition where someone abuses various drugs and develops long-term memory problems (difficulty forming or recalling new memories) as a direct result of the substance use. F19.16 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. F19.16 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. F19.16 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. F19.16 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.

Which HCC does F19.16 map to under V28?

F19.16 maps to CMS-HCC V28 135 (Drug Use with Psychotic Complications). The category number and label come from the CMS-HCC V28 model file for payment year 2026.

What does F19.16 pay in RAF?

F19.16 carries a community, non-dual, aged (CNA) RAF weight of 0.424 under CMS-HCC V28 for payment year 2026. The weight comes from the CMS V28 relative-factor file, not a hand-typed table.

What is the V28 vs V24 difference for F19.16?

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 F19.16, V28 maps to Drug Use with Psychotic Complications at RAF 0.424 while V24 mapped to Substance Use with Psychotic Complications at RAF 0.329. Both models can still appear in legacy data and in payer-specific lookback periods.

2026 ICD-10-CM F19.16: Other psychoactive

F19.16 maps to CMS-HCC V28 135 (RAF 0.424). Documentation must support MEAT. MEAT criteria · RAF calculator · HCC coding software

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Code lookupF19.16Effective 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)

F19.16

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

Other psychoactive substance abuse with psychoactive substance-induced persisting amnestic disorder

A condition where someone abuses various drugs and develops long-term memory problems (difficulty forming or recalling new memories) as a direct result of the substance use.

Buddy Insight

This code captures substance-induced persisting amnestic disorder, a severe and lasting memory impairment caused by other psychoactive substance abuse.

CMS-HCC V28

Mapped

HCC 135

Drug Use with Psychotic Compl...

RAF 0.424

CMS-HCC V24

Mapped

HCC 54

Substance Use with Psychotic ...

RAF 0.329

ACA/HHS

Mapped

HCC 81

HHS-HCC 81

Varies by metal level

ESRD/PACE

Mapped

HCC 54

Substance Use with Psychotic ...

RAF 0.111

RXHCC

N/A

—

Not risk-adjusted for this model/period.

Not mapped

Code Book Path

Official

F19Other psychoactive substance related disorders

F19.1Other psychoactive substance abuse

F19.16Other psychoactive substance abuse with psychoactive substance-induced persisting amnestic disorder

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for F19.16 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for F19.16 in this effective period.

Related Child Codes

Official

F19.10Other psychoactive substance abuse, uncomplicated

F19.11Other psychoactive substance abuse, in remission

F19.12Other psychoactive substance abuse with intoxication

F19.13Other psychoactive substance abuse with withdrawal

F19.14Other psychoactive substance abuse with psychoactive substance-induced mood disorder

Includes

Official

ICD-10-CM does not list Includes notes for F19.16 in this effective period.

Excludes 1

Official

other psychoactive substance dependence (F19.2-)
other psychoactive substance use, unspecified (F19.9-)

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for F19.16 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for F19.16 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for F19.16 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

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

Neuropsychological or clinical assessment documenting persistent memory impairment, particularly anterograde amnesia

Provider documentation establishing the amnestic disorder persists beyond intoxication or withdrawal and is directly caused by the substance

MEAT Support

HCC Buddy guidance

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

Neuropsychological or clinical assessment documenting persistent memory impairment, particularly anterograde amnesia

Provider documentation establishing the amnestic disorder persists beyond intoxication or withdrawal and is directly caused by the substance

Audit Caution

HCC Buddy guidance

Using F19 codes when a more specific substance category exists — always check if the substance is better classified under F10 (alcohol), F11 (opioids), F12 (cannabis), F13 (sedatives), F14 (cocaine), F15 (stimulants), F16 (hallucinogens), or F18 (inhalants)

Coding abuse when documentation supports dependence — the DSM-5 uses 'substance use disorder' with severity levels; ICD-10 still distinguishes abuse from dependence, requiring careful mapping

Failing to document the 'persisting' nature of the condition — this code requires cognitive deficits that continue beyond the period of active intoxication or withdrawal

Not differentiating from transient cognitive impairment during intoxication, which should be coded as intoxication rather than persisting dementia or amnestic disorder

Common Mistakes

HCC Buddy guidance

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

F19.17 (Substance-induced persisting dementia) — dementia involves broader cognitive decline beyond just memory impairment

R41.3 (Other amnesia) — use for amnesia not caused by substance use

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 F19.16 an HCC code?

Yes. F19.16 (Other psychoactive substance abuse with psychoactive substance-induced persisting amnestic disorder) maps to Drug Use with Psychotic Complications under the CMS-HCC V28 risk adjustment model (and Substance Use with Psychotic Complications under V24), with a community non-dual aged RAF of 0.424. It is billable for payment year 2026.

Coder answer: F19.16 is billable and maps to V28 HCC 135, Drug Use with Psychotic Complications. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code: F19.16
Description: Other psychoactive substance abuse with psychoactive substance-induced persisting amnestic disorder
HCC (V28): HCC 135 — Drug Use with Psychotic Complications
RAF: 0.424
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 135, Drug Use with Psychotic Complications

0.424

V24HCC 54, Substance Use with Psychotic Complications

0.329

ESRDHCC 54, Substance Use with Psychotic Complications

0.111

Each model's RAF is its CMS base weight for that model's standard population, so 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 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.

Work F19.16 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for F19.16

For F19.16 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 F19.16 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

F19.16 is the ICD-10-CM diagnosis code for other psychoactive substance abuse with psychoactive substance-induced persisting amnestic disorder. A condition where someone abuses various drugs and develops long-term memory problems (difficulty forming or recalling new memories) as a direct result of the substance use. F19.16 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, F19.16 maps to Drug Use with Psychotic Complications (HCC 135) with a community, non-dual, aged base RAF weight of 0.424. Under the older CMS-HCC V24 model, F19.16 maps to Substance Use with Psychotic Complications (HCC 54) 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.

Document the duration and severity of memory impairment in the clinical record. Because F19.16 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 F19.16 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Document the duration and severity of memory impairment in the clinical record
•Ensure the amnestic disorder persists beyond the acute withdrawal period

Clinical Significance

This code captures substance-induced persisting amnestic disorder, a severe and lasting memory impairment caused by other psychoactive substance abuse. This condition indicates significant neurotoxic damage that persists beyond the period of active substance use and requires ongoing neuropsychological monitoring. These patients have elevated care needs due to functional impairment from memory deficits.

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
✓Neuropsychological or clinical assessment documenting persistent memory impairment, particularly anterograde amnesia
✓Provider documentation establishing the amnestic disorder persists beyond intoxication or withdrawal and is directly caused by the substance
✓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
•F19.17 (Substance-induced persisting dementia): dementia involves broader cognitive decline beyond just memory impairment
•R41.3 (Other amnesia): use for amnesia not caused by substance use
•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