F19.951
BillableOther psychoactive substance use, unspecified with psychoactive substance-induced psychotic disorder with hallucinations
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F19.951 an HCC code?
Yes. F19.951 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 F19.951
For F19.951 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 F19.951 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F19.951 is the ICD-10-CM diagnosis code for other psychoactive substance use, unspecified with psychoactive substance-induced psychotic disorder with hallucinations. A psychotic condition characterized by seeing, hearing, or sensing things that aren't real (hallucinations) that develops directly from the use of various psychoactive substances. F19.951 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, F19.951 maps to Drug/Alcohol Psychosis (HCC 135) with a community, non-dual, aged base RAF weight of 0.000. Under the older V24 model, F19.951 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.
Specify the type of hallucinations (visual, auditory, tactile) in clinical documentation when available. Because F19.951 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 F19.951 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Specify the type of hallucinations (visual, auditory, tactile) in clinical documentation when available
- •Confirm the hallucinations are temporally related to substance use
Clinical Significance
Other psychoactive substance use, unspecified with substance-induced psychotic disorder with hallucinations represents a severe psychiatric presentation where substance use has caused the patient to experience false sensory perceptions. Hallucinations may be visual, auditory, or tactile and represent a significant danger to the patient and others. This high-acuity diagnosis typically requires inpatient psychiatric care and maps to a higher HCC than simple substance use disorders.
Documentation Requirements
- ✓Documentation of psychoactive substance use with temporal relationship to hallucination onset
- ✓Description of the type of hallucinations (visual, auditory, tactile, olfactory)
- ✓Provider determination that hallucinations are substance-induced, not from a primary psychotic disorder
- ✓Assessment of the patient's insight into the hallucinations
- ✓Safety assessment including danger to self and others
- ✓Psychiatric evaluation and pharmacological treatment plan
Commonly Confused Codes
- •F19.950 — Substance-induced psychotic disorder with DELUSIONS, not hallucinations; different primary symptom
- •F19.922 — Intoxication with PERCEPTUAL DISTURBANCE is less severe and occurs only during acute intoxication
- •F19.932 — Withdrawal with perceptual disturbance occurs specifically during withdrawal, not as a separate psychotic disorder
- •F20.0 — Paranoid schizophrenia has persistent hallucinations beyond substance use; different etiology
- •F29 — Unspecified psychosis should not be used when the substance-induced etiology is documented