F19.280
BillableOther psychoactive substance dependence with psychoactive substance-induced anxiety disorder
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F19.280 an HCC code?
Yes. F19.280 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
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 F19.280
For F19.280 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 F19.280 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F19.280 is the ICD-10-CM diagnosis code for other psychoactive substance dependence with psychoactive substance-induced anxiety disorder. Addiction to various drugs or substances that causes excessive worry, fear, or panic. F19.280 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, F19.280 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, F19.280 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 specific anxiety symptoms and their relationship to substance use. Because F19.280 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 F19.280 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document the specific anxiety symptoms and their relationship to substance use
- •Differentiate between substance-induced anxiety and primary anxiety disorders in the clinical documentation
Clinical Significance
Other psychoactive substance dependence with substance-induced anxiety disorder represents a dual diagnosis where the patient's anxiety is directly caused by their substance dependence. This is critical for risk adjustment because it captures both the severity of the addiction and the psychiatric comorbidity, reflecting higher resource utilization for integrated behavioral health treatment. Accurate capture ensures appropriate reimbursement for the complex care these patients require.
Documentation Requirements
- ✓Identification of the specific psychoactive substance(s) involved in the dependence
- ✓Documentation of dependence criteria met (tolerance, withdrawal, compulsive use, failed attempts to quit)
- ✓Description of anxiety symptoms (generalized anxiety, panic attacks, phobias) and their temporal relationship to substance use
- ✓Clinical determination that the anxiety disorder is substance-induced rather than a primary anxiety disorder
- ✓Current treatment plan addressing both the dependence and the anxiety disorder
- ✓Assessment of severity and functional impact of both conditions