What is ICD-10 code F19.920?

F19.920 is the ICD-10-CM diagnosis code for Other psychoactive substance use, unspecified with intoxication, uncomplicated. Current use of various psychoactive substances with intoxication symptoms but without severe complications. It belongs to the ICD-10-CM chapter for mental, behavioral and neurodevelopmental disorders (f01-f99). F19.920 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. F19.920 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. F19.920 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. F19.920 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 F19.920?

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 F19.920, 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 F19.920?

This code indicates active intoxication from unspecified psychoactive substances without delirium or perceptual disturbances Document the specific substance if possible to use a more specific code Because F19.920 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.

F19.920 ICD-10 Code: Other psychoactive substance

ICD-10-CM Code View

HCC Buddy Code Card

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

Code lookupF19.920Effective 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)

F19.920

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

Other psychoactive substance use, unspecified with intoxication, uncomplicated

Current use of various psychoactive substances with intoxication symptoms but without severe complications.

Buddy Insight

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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Code Book Path

Official

F19.9Other psychoactive substance use, unspecified

F19.92Other psychoactive substance use, unspecified with intoxication

F19.920Other psychoactive substance use, unspecified with intoxication, uncomplicated

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for F19.920 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for F19.920 in this effective period.

Related Child Codes

Official

F19.921Other psychoactive substance use, unspecified with intoxication with delirium

F19.922Other psychoactive substance use, unspecified with intoxication with perceptual disturbance

F19.929Other psychoactive substance use, unspecified with intoxication, unspecified

Includes

Official

ICD-10-CM does not list Includes notes for F19.920 in this effective period.

Excludes 1

Official

other psychoactive substance use, unspecified with withdrawal (F19.93)

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for F19.920 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for F19.920 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for F19.920 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Documentation of current substance use (not just historical use)

Evidence of intoxication at the time of evaluation (clinical signs, lab results, patient report)

Absence of delirium or perceptual disturbances to support 'uncomplicated' designation

Identification of the substance(s) used when possible

MEAT Support

HCC Buddy guidance

Documentation of current substance use (not just historical use)

Evidence of intoxication at the time of evaluation (clinical signs, lab results, patient report)

Absence of delirium or perceptual disturbances to support 'uncomplicated' designation

Identification of the substance(s) used when possible

Audit Caution

HCC Buddy guidance

Failing to query the provider about abuse or dependence criteria, which would change the code to F19.120 or F19.220

Using this code for historical substance use when the patient is not currently intoxicated

Not distinguishing between uncomplicated intoxication and intoxication with delirium or perceptual disturbances

Coding substance intoxication without documenting the clinical findings that support the diagnosis

Common Mistakes

HCC Buddy guidance

F19.120 — Substance ABUSE with intoxication, uncomplicated; use when abuse criteria are documented

F19.220 — Substance DEPENDENCE with intoxication, uncomplicated; use when dependence criteria are met

F19.921 — Unspecified use with intoxication WITH delirium; distinguish based on mental status

F19.922 — Unspecified use with intoxication WITH perceptual disturbance; distinguish based on hallucination presence

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 F19.920 an HCC code?

Yes. F19.920 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 F19.920

For F19.920to 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 F19.920 during that encounter, not just copy-forwarded from a problem list.

What This Code Means

F19.920 is the ICD-10-CM diagnosis code for other psychoactive substance use, unspecified with intoxication, uncomplicated. Current use of various psychoactive substances with intoxication symptoms but without severe complications. F19.920 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, F19.920 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, F19.920 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.

This code indicates active intoxication from unspecified psychoactive substances without delirium or perceptual disturbances. Because F19.920 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 F19.920 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•This code indicates active intoxication from unspecified psychoactive substances without delirium or perceptual disturbances
•Document the specific substance if possible to use a more specific code

Clinical Significance

Other psychoactive substance use, unspecified with intoxication, uncomplicated represents a patient currently under the influence of a psychoactive substance without meeting criteria for abuse or dependence, and without severe complications like delirium. This code is important in risk adjustment because it captures substance use disorders that still require monitoring and intervention. The 'unspecified' use pattern often represents an opportunity for provider education on documenting the severity of substance use.

Documentation Requirements

✓Documentation of current substance use (not just historical use)
✓Evidence of intoxication at the time of evaluation (clinical signs, lab results, patient report)
✓Absence of delirium or perceptual disturbances to support 'uncomplicated' designation
✓Identification of the substance(s) used when possible
✓Assessment of whether use meets criteria for abuse or dependence
✓Clinical evaluation of the intoxication severity

Commonly Confused Codes

•F19.120 — Substance ABUSE with intoxication, uncomplicated; use when abuse criteria are documented
•F19.220 — Substance DEPENDENCE with intoxication, uncomplicated; use when dependence criteria are met
•F19.921 — Unspecified use with intoxication WITH delirium; distinguish based on mental status
•F19.922 — Unspecified use with intoxication WITH perceptual disturbance; distinguish based on hallucination presence