What is ICD-10 code F19.27?

F19.27 is the ICD-10-CM diagnosis code for Other psychoactive substance dependence with psychoactive substance-induced persisting dementia. Long-term addiction to various drugs or substances that causes permanent brain damage resulting in memory loss and cognitive decline. F19.27 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. F19.27 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. F19.27 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. F19.27 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 F19.27 map to under V28?

F19.27 maps to CMS-HCC V28 HCC 135 (Drug Use with Psychotic Complications). The category numbers, labels, and conditions come from the CMS-HCC V28 model file for payment year 2026.

2026 ICD-10-CM F19.27: Other psychoactive

F19.27 maps to CMS-HCC V28 135. A source-labeled RAF reference is available. Documentation must support MEAT. MEAT criteria · RAF Calculator · HCC Buddy coding tools

ICD-10-CM Code View

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Code lookupF19.27Effective 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)

F19.27

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

Other psychoactive substance dependence with psychoactive substance-induced persisting dementia

Long-term addiction to various drugs or substances that causes permanent brain damage resulting in memory loss and cognitive decline.

Buddy Insight

This code identifies persisting dementia caused by other psychoactive substance exposure, representing irreversible neurotoxic brain damage.

CMS-HCC V28

Mapped

HCC 135

Drug Use with Psychotic Compl...

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 081

HHS-HCC 081 adult, RAF varies...

Code-level coefficient reference

ESRD/PACE

Mapped

HCC 54

Substance Use with Psychotic ...

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

F19.27Other psychoactive substance dependence with psychoactive substance-induced persisting dementia

Inclusion Terms

Official

Other (or unknown) substance use disorder, moderate, with other (or unknown) substance induced major neurocognitive disorder
Other (or unknown) substance use disorder, severe, with other (or unknown) substance induced major neurocognitive disorder

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for F19.27 in this effective period.

Related Child Codes

Official

F19.20Other psychoactive substance dependence, uncomplicated

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

Includes

Official

ICD-10-CM does not list Includes notes for F19.27 in this effective period.

Excludes 1

Official

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

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for F19.27 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for F19.27 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for F19.27 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

Cognitive assessment documenting persistent deficits in memory, executive function, or other cognitive domains

Provider documentation that the dementia is caused by substance use and persists beyond the period of acute intoxication or withdrawal

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

Cognitive assessment documenting persistent deficits in memory, executive function, or other cognitive domains

Provider documentation that the dementia is caused by substance use and persists beyond the period of acute intoxication or withdrawal

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

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

F19.10-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

F19.26 (Substance-induced persisting amnestic disorder) — amnestic disorder involves primarily memory impairment without the broader cognitive decline of dementia

F01-F03 (Vascular or unspecified dementia) — for primary dementia 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 F19.27 an HCC code?

Yes. F19.27 (Other psychoactive substance dependence with psychoactive substance-induced persisting dementia) 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: F19.27 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: F19.27
Description: Other psychoactive substance dependence with psychoactive substance-induced persisting dementia
HCC (V28): HCC 135 — Drug Use with Psychotic Complications
RAF reference coefficient: 0.424
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 135, Drug Use with Psychotic Complications

0.424

ESRDHCC 54, Substance Use with Psychotic 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 F19.27 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT Criteria for F19.27

For F19.27 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 F19.27 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

F19.27 is the ICD-10-CM diagnosis code for other psychoactive substance dependence with psychoactive substance-induced persisting dementia. Long-term addiction to various drugs or substances that causes permanent brain damage resulting in memory loss and cognitive decline. F19.27 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, F19.27 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 F19.27; use the applicable model and payment year when reviewing the V28 mapping. 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. 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.

Document the severity and specific cognitive deficits observed. Because F19.27 maps to an HCC category, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) before the diagnosis is used for risk adjustment. 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 F19.27 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Document the severity and specific cognitive deficits observed
•Ensure the dementia is documented as persisting, indicating it continues even after substance use cessation

Clinical Significance

This code identifies persisting dementia caused by other psychoactive substance exposure, representing irreversible neurotoxic brain damage. Substance-induced persisting dementia indicates permanent cognitive decline requiring long-term supportive care, cognitive rehabilitation, and ongoing supervision. Accurate documentation is essential for risk adjustment as these patients have substantially elevated care needs comparable to other dementia etiologies.

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
✓Cognitive assessment documenting persistent deficits in memory, executive function, or other cognitive domains
✓Provider documentation that the dementia is caused by substance use and persists beyond the period of acute intoxication or withdrawal
✓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
•F19.26 (Substance-induced persisting amnestic disorder): amnestic disorder involves primarily memory impairment without the broader cognitive decline of dementia
•F01-F03 (Vascular or unspecified dementia): for primary dementia 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