What is ICD-10 code F19.20?

F19.20 is the ICD-10-CM diagnosis code for Other psychoactive substance dependence, uncomplicated. It belongs to the ICD-10-CM chapter for mental, behavioral and neurodevelopmental disorders (f01-f99). F19.20 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. F19.20 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. F19.20 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. F19.20 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 F19.20 map to under V28?

F19.20 maps to CMS-HCC V28 HCC 137 (Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications). The category numbers, labels, and conditions come from the CMS-HCC V28 model file for payment year 2026.

What documentation supports F19.20?

Other psychoactive substance dependence, uncomplicated, the catch-all for substances not captured by F10-F18 (e.g., inhalants mixed with others, unidentified substances). Do not default to F19.20 when a specific substance code applies. F10 (alcohol), F11 (opioids), F13 (sedatives), F14 (cocaine), F15 (other stimulants) should be used whenever the substance is identified. V28 HCC 137 (Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications) at RAF 0.424. F19 codes risk-adjust like the substance-specific dependence codes; the substance specificity matters for chart accuracy more than for RAF. For F19.20, 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. See the MEAT criteria checklist at /meat-criteria for what Monitor, Evaluate, Assess, or Treat looks like in a note. One mnemonic element does not establish that a diagnosis is reportable.

2026 ICD-10-CM F19.20: Other psychoactive

F19.20 maps to CMS-HCC V28 137. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · free HCC coding tools

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Code lookupF19.20

Effective 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)

F19.20

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

Other psychoactive substance dependence, uncomplicated

This code describes a person who is dependent on a psychoactive substance (such as inhalants, hallucinogens, or other drugs not specified elsewhere) without any current complications like withdrawal symptoms or behavioral problems. It indicates an ongoing substance use disorder that is stable or uncomplicated at the time of diagnosis.

Buddy Insight

This code identifies uncomplicated other psychoactive substance dependence without current complications, intoxication, or withdrawal.

Overview Risk Models Code Book Documentation Audit Notes Edition comparison

CMS-HCC V28

Mapped

HCC 137

Drug Use Disorder, Moderate/S...

Code-level coefficient reference

CMS-HCC V24

Historical

Not used for standard CY2026 Medicare Advantage payment. Select a historical period to review V24.

Not used for CY2026 payment

ACA/HHS

Mapped

HCC 082

HHS-HCC 082 adult, RAF varies...

Code-level coefficient reference

ESRD/PACE

Mapped

HCC 55

Substance Use Disorder/Modera...

Code-level coefficient reference

RXHCC

N/A

—

Not risk-adjusted for this model/period.

Not mapped

Code Book Path

Official

F19Other psychoactive substance related disorders F19.2Other psychoactive substance dependence F19.20Other psychoactive substance dependence, uncomplicated

Inclusion Terms

Official

Other (or unknown) substance use disorder, moderate
Other (or unknown) substance use disorder, severe

Excludes 2

Official

symptoms, signs and abnormal clinical laboratory findings, not elsewhere classified (R00-R99)Inherited from F01-F99

Related Codes

Official

F19.21Other psychoactive substance dependence, in remission F19.22Other psychoactive substance dependence with intoxication F19.23Other psychoactive substance dependence with withdrawal F19.24Other psychoactive substance dependence with psychoactive substance-induced mood disorder F19.25Other psychoactive substance dependence with psychoactive substance-induced psychotic disorder

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 abuse (F19.1-)Inherited from F19.2
other psychoactive substance use, unspecified (F19.9-)Inherited from F19.2

Code First

Official

No Code First sequencing instructions are included in this display for F19.20. Check the code and parent instructions in the Code Book.

Use Additional

Official

No Use Additional Code instructions are included in this display for F19.20. Check the code and parent instructions in the Code Book.

Code Also

Official

No Code Also instructions are included in this display for F19.20. Check the code and parent instructions in the Code Book.

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 dependence criteria: tolerance, withdrawal symptoms, compulsive use despite harm, or inability to control use

Assessment and plan addressing the substance use disorder with treatment approach documented

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 dependence criteria: tolerance, withdrawal symptoms, compulsive use despite harm, or inability to control use

Assessment and plan addressing the substance use disorder with treatment approach documented

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)

Assigning dependence without documented criteria — dependence requires evidence of tolerance, withdrawal, compulsive use patterns, or continued use despite harm

Not documenting the encounter as addressing the substance use disorder in the assessment and plan — the condition must be actively managed or monitored during the visit to support coding

Common Mistakes

HCC Buddy guidance

F19.10-F19.19 (Other psychoactive substance abuse) — abuse indicates a less severe use pattern without meeting dependence criteria

F19.90-F19.99 (Other psychoactive substance use, unspecified) — unspecified use is used when the severity of the use disorder is not documented

F19.21 (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

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 F19.20 an HCC code?

Yes. F19.20 (Other psychoactive substance dependence, uncomplicated) maps to HCC 137, Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.424. 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: F19.20 is billable and maps to V28 HCC 137, Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code: F19.20
Description: Other psychoactive substance dependence, uncomplicated
HCC (V28): HCC 137 — Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications
RAF reference coefficient: 0.424
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 137, Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications

0.424

ESRDHCC 55, Substance Use Disorder/Moderate/Severe/Substance Use with Complications

Not separately weighted

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 F19.20 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for F19.20

For F19.20, 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

F19.20 is the ICD-10-CM diagnosis code for other psychoactive substance dependence, uncomplicated. This code describes a person who is dependent on a psychoactive substance (such as inhalants, hallucinogens, or other drugs not specified elsewhere) without any current complications like withdrawal symptoms or behavioral problems. It indicates an ongoing substance use disorder that is stable or uncomplicated at the time of diagnosis. F19.20 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, F19.20 maps to Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications (HCC 137) with a source-labeled community, non-dual, aged reference coefficient of 0.424. No V24 mapping is shown for F19.20; use the applicable model and payment year when reviewing the V28 mapping. 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.

Other psychoactive substance dependence, uncomplicated, the catch-all for substances not captured by F10-F18 (e.g., inhalants mixed with others, unidentified substances). For F19.20, 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 F19.20 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Other psychoactive substance dependence, uncomplicated, the catch-all for substances not captured by F10-F18 (e.g., inhalants mixed with others, unidentified substances).
•Do not default to F19.20 when a specific substance code applies. F10 (alcohol), F11 (opioids), F13 (sedatives), F14 (cocaine), F15 (other stimulants) should be used whenever the substance is identified.

Clinical Significance

This code identifies uncomplicated other psychoactive substance dependence 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 dependence criteria: tolerance, withdrawal symptoms, compulsive use despite harm, or inability to control use
✓Assessment and plan addressing the substance use disorder with treatment approach documented

Commonly Confused Codes

•F19.10-F19.19 (Other psychoactive substance abuse): abuse indicates a less severe use pattern without meeting dependence criteria
•F19.90-F19.99 (Other psychoactive substance use, unspecified): unspecified use is used when the severity of the use disorder is not documented
•F19.21 (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