What is ICD-10 code F19.220?

F19.220 is the ICD-10-CM diagnosis code for Other psychoactive substance dependence with intoxication, uncomplicated. A person who is dependent on psychoactive substances and is currently intoxicated without severe complications. It belongs to the ICD-10-CM chapter for mental, behavioral and neurodevelopmental disorders (f01-f99). F19.220 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. F19.220 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. F19.220 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. F19.220 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.

What is the V28 vs V24 difference for F19.220?

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 F19.220, V28 maps to Drug Use Disorder/Substance Use Disorder, Moderate/Severe at RAF 0.358 while V24 mapped to Drug/Alcohol Dependence at RAF 0.334. Both models can still appear in legacy data and in payer-specific lookback periods.

What should coders know when reporting F19.220?

Document the substance(s) causing intoxication and the severity level Differentiate from complicated intoxication (delirium or perceptual disturbances) Because F19.220 maps to a payment HCC, the documentation must also satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's risk adjustment score.

F19.220 ICD-10 Code: Other psychoactive substance

ICD-10-CM Code View

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Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.

Code lookupF19.220Effective 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)

F19.220

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

Other psychoactive substance dependence with intoxication, uncomplicated

A person who is dependent on psychoactive substances and is currently intoxicated without severe complications.

Buddy Insight

This code identifies uncomplicated other psychoactive substance intoxication with dependence, indicating acute substance effects without severe neuropsychiatric complications.

CMS-HCC V28

Mapped

HCC 137

Drug Use Disorder/Substance U...

RAF 0.358

CMS-HCC V24

Mapped

HCC 55

Drug/Alcohol Dependence

RAF 0.334

ACA/HHS

Not risk-adjusted for this model/period.

RAF 0

ESRD/PACE

Mapped

HCC 55

Drug/Alcohol Dependence

RAF 0.0

RXHCC

Not risk-adjusted for this model/period.

RAF 0

Code Trumping

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Compare selected patient codes to show trumped or trumps impact.

Code Book Path

Official

F19.2Other psychoactive substance dependence

F19.22Other psychoactive substance dependence with intoxication

F19.220Other psychoactive substance dependence with intoxication, uncomplicated

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for F19.220 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for F19.220 in this effective period.

Related Child Codes

Official

F19.221Other psychoactive substance dependence with intoxication delirium

F19.222Other psychoactive substance dependence with intoxication with perceptual disturbance

F19.229Other psychoactive substance dependence with intoxication, unspecified

Includes

Official

ICD-10-CM does not list Includes notes for F19.220 in this effective period.

Excludes 1

Official

other psychoactive substance dependence with withdrawal (F19.23-)

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for F19.220 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for F19.220 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for F19.220 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 dependence criteria: tolerance, withdrawal symptoms, compulsive use despite harm, or inability to control use

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

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

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

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

Using uncomplicated intoxication when delirium or perceptual disturbances are present — always check for signs of confusion, hallucinations, or disorientation that would require a more specific code

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

F19.221 (Intoxication delirium) — requires documented delirium symptoms beyond simple intoxication

F19.222 (Intoxication with perceptual disturbance) — requires documented hallucinations or sensory distortions

Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.

Is F19.220 an HCC code?

Yes. F19.220 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

V28HCC 137, Drug Use Disorder/Substance Use Disorder, Moderate/Severe

0.358

V24HCC 55, Drug/Alcohol Dependence

0.334

ESRDHCC 55, Drug/Alcohol Dependence

0.000

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 F19.220

For F19.220to 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 F19.220 during that encounter, not just copy-forwarded from a problem list.

What This Code Means

F19.220 is the ICD-10-CM diagnosis code for other psychoactive substance dependence with intoxication, uncomplicated. A person who is dependent on psychoactive substances and is currently intoxicated without severe complications. F19.220 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, F19.220 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, F19.220 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.

Document the substance(s) causing intoxication and the severity level. Because F19.220 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 F19.220 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Document the substance(s) causing intoxication and the severity level
•Differentiate from complicated intoxication (delirium or perceptual disturbances)

Clinical Significance

This code identifies uncomplicated other psychoactive substance intoxication with dependence, 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 dependence criteria: tolerance, withdrawal symptoms, compulsive use despite harm, or inability to control use
✓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

•F19.10-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
•F19.221 (Intoxication delirium) — requires documented delirium symptoms beyond simple intoxication
•F19.222 (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