F19.16
BillableOther psychoactive substance abuse with psychoactive substance-induced persisting amnestic disorder
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F19.16 an HCC code?
Yes. F19.16 maps to Drug/Alcohol Psychosis under the CMS-HCC V28 risk adjustment model (and Drug/Alcohol Psychosis 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 F19.16
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.
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/Alcohol Psychosis (HCC 135) with a community, non-dual, aged base RAF weight of 0.000. Under the older V24 model, F19.16 mapped to the same category but with a base RAF weight of 0.434 — V28 recalibrated weights across the entire model. 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