F19.29
BillableOther psychoactive substance dependence with unspecified psychoactive substance-induced disorder
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F19.29 an HCC code?
Yes. F19.29 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 F19.29
For F19.29 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 F19.29 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F19.29 is the ICD-10-CM diagnosis code for other psychoactive substance dependence with unspecified psychoactive substance-induced disorder. Addiction to various drugs or substances that causes other mental health or behavioral problems not specifically described. F19.29 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, F19.29 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, F19.29 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.
Use this code only when a substance-induced disorder is present but does not fit other specified categories. Because F19.29 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 F19.29 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 a substance-induced disorder is present but does not fit other specified categories
- •Document the specific disorder or symptom in the clinical record for future reference and specificity
Clinical Significance
Other psychoactive substance dependence with unspecified substance-induced disorder is an unspecified code indicating the provider has documented both dependence and a substance-induced complication but has not specified the nature of that complication. While it still captures the HCC, it represents a documentation gap that should ideally be resolved through provider query. This code is important for risk adjustment as it reflects the complexity of substance dependence with comorbid complications.
Documentation Requirements
- ✓Identification of the substance(s) involved in the dependence
- ✓Documentation that dependence criteria are met (not just use or abuse)
- ✓Provider statement that a substance-induced disorder is present
- ✓Attempt to clarify the specific type of induced disorder through provider query
- ✓Current treatment plan addressing the dependence
- ✓Functional impact assessment
Commonly Confused Codes
- •F19.20 — Substance dependence, uncomplicated, without any induced disorder; F19.29 requires documentation of an induced disorder
- •F19.288 — Other specified substance-induced disorder, when the disorder IS known but lacks a specific code
- •F19.280-F19.282 — Specific induced disorders (anxiety, sexual dysfunction, sleep) should be used when identified
- •F19.99 — Unspecified substance USE with unspecified induced disorder; F19.29 is for documented dependence