F19.26 ICD-10-CM Code: Other psychoactive substance dependence with psychoactive substance-induced persisting amnestic disorder
F19.26 maps to CMS-HCC V28 135. 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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FY 2026 Apr update / Mental, Behavioral and Neurodevelopmental disorders (F01-F99) / Mental and behavioral disorders due to psychoactive substance use (F10-F19)
F19.26
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceOther psychoactive substance dependence with psychoactive substance-induced persisting amnestic disorder
This code describes a condition where a person is dependent on drugs or substances (other than alcohol, opioids, cannabis, stimulants, hallucinogens, or inhalants) and has developed lasting memory problems as a direct result of that substance use. The memory damage persists even when the person is not actively using the substance.
Buddy Insight
This code captures substance-induced persisting amnestic disorder, a severe and lasting memory impairment caused by other psychoactive substance dependence.
CMS-HCC V28
MappedHCC 135
Coefficient HCC 135: 0.424 (Community Non-Dual Aged (CNA))
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
MappedHCC 081
Code-level coefficient reference
ESRD/PACE
MappedHCC 54
Code-level coefficient reference
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
OfficialNo inclusion terms are included in this display for F19.26. Check the code and parent instructions in the Code Book.
Excludes 2
Official- symptoms, signs and abnormal clinical laboratory findings, not elsewhere classified (R00-R99)Inherited from F01-F99
Related Codes
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
OfficialNo Code First sequencing instructions are included in this display for F19.26. Check the code and parent instructions in the Code Book.
Use Additional
OfficialNo Use Additional Code instructions are included in this display for F19.26. Check the code and parent instructions in the Code Book.
Code Also
OfficialNo Code Also instructions are included in this display for F19.26. Check the code and parent instructions in the Code Book.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
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 F19.26 an HCC code?
Yes. F19.26 (Other psychoactive substance dependence with psychoactive substance-induced persisting amnestic disorder) maps to HCC 135, Drug Use with 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: F19.26 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
- F19.26
- Description
- Other psychoactive substance dependence with psychoactive substance-induced persisting amnestic disorder
- HCC (V28)
- HCC 135 — Drug Use with Psychotic Complications
- RAF reference coefficient
- 0.424
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
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 F19.26 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for F19.26
For F19.26, 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
F19.26 is the ICD-10-CM diagnosis code for other psychoactive substance dependence with psychoactive substance-induced persisting amnestic disorder. This code describes a condition where a person is dependent on drugs or substances (other than alcohol, opioids, cannabis, stimulants, hallucinogens, or inhalants) and has developed lasting memory problems as a direct result of that substance use. The memory damage persists even when the person is not actively using the substance. F19.26 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, F19.26 maps to Drug Use with Psychotic Complications (HCC 135) with a source-labeled community, non-dual, aged reference coefficient of 0.424. No V24 mapping is shown for F19.26; 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.
Use this code only when both substance dependence AND persisting amnestic disorder are documented; the amnestic disorder must be specifically attributed to the substance use. For F19.26, 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 F19.26 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 both substance dependence AND persisting amnestic disorder are documented; the amnestic disorder must be specifically attributed to the substance use
- •The 'F19' category is for 'other psychoactive substances' - verify the specific substance is not better classified under F10-F18 (alcohol, opioids, cannabis, stimulants, hallucinogens, inhalants, or sedatives)
Clinical Significance
This code captures substance-induced persisting amnestic disorder, a severe and lasting memory impairment caused by other psychoactive substance dependence. 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 dependence criteria: tolerance, withdrawal symptoms, compulsive use despite harm, or inability to control use
- ✓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
- •F19.10-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
- •F19.27 (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