F19.94 ICD-10-CM Code: Other psychoactive substance use, unspecified with psychoactive substance-induced mood disorder
F19.94 maps to CMS-HCC V28 137. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · HCC coding software
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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)
F19.94
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceOther psychoactive substance use, unspecified with psychoactive substance-induced mood disorder
A condition where someone uses various psychoactive substances and develops mood problems like depression or mania as a direct result of the substance use.
Buddy Insight
Other psychoactive substance use, unspecified with substance-induced mood disorder captures mood disturbances (depression, mania, or mixed states) directly caused by psychoactive substance use.
CMS-HCC V28
MappedHCC 137
Coefficient HCC 137: 0.424 (Community Non-Dual Aged (CNA))
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
MappedHCC 082
Code-level coefficient reference
ESRD/PACE
MappedHCC 55
Code-level coefficient reference
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
Official- Other (or unknown) substance-induced bipolar or related disorder, without use disorder
- Other (or unknown) substance-induced depressive disorder, without use disorder
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 F19.9
- other psychoactive substance dependence (F19.2-)Inherited from F19.9
Code First
OfficialNo Code First sequencing instructions are included in this display for F19.94. Check the code and parent instructions in the Code Book.
Use Additional
OfficialNo Use Additional Code instructions are included in this display for F19.94. Check the code and parent instructions in the Code Book.
Code Also
OfficialNo Code Also instructions are included in this display for F19.94. 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 F19.94 an HCC code?
Yes. F19.94 (Other psychoactive substance use, unspecified with psychoactive substance-induced mood disorder) maps to HCC 137, Drug Use Disorder, Moderate/Severe, or Drug Use with Non-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: F19.94 is billable and maps to V28 HCC 137, Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.
- Code
- F19.94
- Description
- Other psychoactive substance use, unspecified with psychoactive substance-induced mood disorder
- HCC (V28)
- HCC 137 — Drug Use Disorder, Moderate/Severe, or Drug Use with Non-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 F19.94 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for F19.94
For F19.94, 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
F19.94 is the ICD-10-CM diagnosis code for other psychoactive substance use, unspecified with psychoactive substance-induced mood disorder. A condition where someone uses various psychoactive substances and develops mood problems like depression or mania as a direct result of the substance use. F19.94 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, F19.94 maps to Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications (HCC 137) with a source-labeled community, non-dual, aged reference coefficient of 0.424. No V24 mapping is shown for F19.94; 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.
Document the specific substance(s) used when possible, though this code is for unspecified substances. For F19.94, 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 F19.94 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document the specific substance(s) used when possible, though this code is for unspecified substances
- •Ensure the mood disorder is documented as substance-induced rather than a primary mood disorder
Clinical Significance
Other psychoactive substance use, unspecified with substance-induced mood disorder captures mood disturbances (depression, mania, or mixed states) directly caused by psychoactive substance use. Substance-induced mood disorders are common and contribute significantly to treatment complexity, as they require addressing both the substance use and the mood symptoms. Accurate coding is essential for risk adjustment and for distinguishing these from primary mood disorders.
Documentation Requirements
- ✓Documentation of current psychoactive substance use
- ✓Description of the specific mood disturbance (depressive symptoms, manic symptoms, or mixed features)
- ✓Provider determination that the mood disorder is substance-induced, not a primary mood disorder
- ✓Temporal relationship showing mood symptoms developed during or shortly after substance use
- ✓Assessment of whether mood symptoms resolve with abstinence from the substance
- ✓Treatment plan addressing both the substance use and the mood disturbance
Commonly Confused Codes
- •F32.9: Major depressive disorder, unspecified should be used for primary depression not caused by substance use
- •F19.14: Substance ABUSE with induced mood disorder; verify the use pattern documentation
- •F19.24: Substance DEPENDENCE with induced mood disorder; use when dependence criteria are documented
- •F30.10: Manic episode should be used for primary mania not caused by substance use
- •F39: Unspecified mood disorder should not be used when the substance-induced etiology is documented