F19.950
BillableOther psychoactive substance use, unspecified with psychoactive substance-induced psychotic disorder with delusions
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F19.950 an HCC code?
Yes. F19.950 maps to Drug/Alcohol Psychosis under the CMS-HCC V28 risk adjustment model (and Drug/Alcohol Psychosis 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 F19.950
For F19.950 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 F19.950 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F19.950 is the ICD-10-CM diagnosis code for other psychoactive substance use, unspecified with psychoactive substance-induced psychotic disorder with delusions. A psychotic condition characterized by false beliefs (delusions) that develops directly from the use of various psychoactive substances. F19.950 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, F19.950 maps to Drug/Alcohol Psychosis (HCC 135) with a community, non-dual, aged base RAF weight of 0.000. Under the older V24 model, F19.950 mapped to the same category but with a base RAF weight of 0.434 — V28 recalibrated weights across the entire model. 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.
Distinguish between substance-induced psychosis and primary psychotic disorders. Because F19.950 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 F19.950 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Distinguish between substance-induced psychosis and primary psychotic disorders
- •Document the timeline showing substance use preceded the psychotic symptoms
Clinical Significance
Other psychoactive substance use, unspecified with substance-induced psychotic disorder with delusions represents a serious psychiatric presentation where substance use has triggered false, fixed beliefs (delusions). This is a high-acuity condition requiring psychiatric intervention and often inpatient care. Accurate capture is critical for risk adjustment because substance-induced psychotic disorders map to a higher HCC than substance dependence alone, reflecting the significantly greater treatment burden.
Documentation Requirements
- ✓Documentation of psychoactive substance use temporally related to psychotic onset
- ✓Description of the specific delusions (persecutory, grandiose, referential, etc.)
- ✓Provider determination that psychosis is substance-induced rather than a primary psychotic disorder
- ✓Evidence that psychotic symptoms developed during or shortly after substance intoxication or withdrawal
- ✓Assessment of the patient's danger to self or others
- ✓Psychiatric evaluation and treatment plan including antipsychotic medication if indicated
Commonly Confused Codes
- •F19.951 — Substance-induced psychotic disorder with HALLUCINATIONS, not delusions; key distinction in symptom type
- •F22 — Delusional disorder is a primary psychotic condition, not substance-induced
- •F20.0 — Paranoid schizophrenia has persistent psychosis beyond substance use periods
- •F19.921 — Intoxication with delirium may include delusion-like symptoms but is a different diagnosis
- •F19.150/F19.250 — Use these for substance ABUSE or DEPENDENCE with induced psychosis with delusions