Yes. F19.951 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. F19.951 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 F19.951?

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 F19.951, V28 maps to Drug Use with Psychotic Complications at RAF 0.424 while V24 mapped to Substance Use with Psychotic Complications at RAF 0.329. Both models can still appear in legacy data and in payer-specific lookback periods.

What should coders know when reporting F19.951?

Specify the type of hallucinations (visual, auditory, tactile) in clinical documentation when available Confirm the hallucinations are temporally related to substance use Because F19.951 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.

2026 ICD-10-CM F19.951: Other psychoactive

ICD-10-CM Code View

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Code lookupF19.951Effective 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)

F19.951

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

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.

Buddy Insight

CMS-HCC V28

Mapped

HCC 135

Drug Use with Psychotic Compl...

RAF 0.424

CMS-HCC V24

Mapped

HCC 54

Substance Use with Psychotic ...

RAF 0.329

ACA/HHS

Mapped

HCC 81

HHS-HCC 81

Varies by metal level

ESRD/PACE

Mapped

HCC 54

Substance Use with Psychotic ...

RAF 0.111

RXHCC

N/A

—

Not risk-adjusted for this model/period.

Not mapped

Code Book Path

Official

F19.9Other psychoactive substance use, unspecified

F19.95Other psychoactive substance use, unspecified with psychoactive substance-induced psychotic disorder

F19.951Other psychoactive substance use, unspecified with psychoactive substance-induced psychotic disorder with hallucinations

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for F19.951 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for F19.951 in this effective period.

Related Child Codes

Official

F19.950Other psychoactive substance use, unspecified with psychoactive substance-induced psychotic disorder with delusions

F19.959Other psychoactive substance use, unspecified with psychoactive substance-induced psychotic disorder, unspecified

Includes

Official

ICD-10-CM does not list Includes notes for F19.951 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for F19.951 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for F19.951 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for F19.951 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for F19.951 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

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

MEAT Support

HCC Buddy guidance

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

Audit Caution

HCC Buddy guidance

Coding intoxication with perceptual disturbance (F19.922) when the hallucinations represent a true psychotic disorder rather than simple intoxication effects

Using primary psychotic disorder codes when documentation clearly links hallucinations to substance use

Not distinguishing between hallucinations (false perceptions) and illusions (misperceptions of real stimuli)

Failing to capture this higher-value HCC code when hallucinations are documented in the context of substance use

Common Mistakes

HCC Buddy guidance

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

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 F19.951 an HCC code?

Yes. F19.951 (Other psychoactive substance use, unspecified with psychoactive substance-induced psychotic disorder with hallucinations) maps to Drug Use with Psychotic Complications under the CMS-HCC V28 risk adjustment model (and Substance Use with Psychotic Complications under V24), with a community non-dual aged RAF of 0.424. It is billable for payment year 2026.

Coder answer: F19.951 is billable and maps to V28 HCC 135, Drug Use with Psychotic Complications. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code: F19.951
Description: Other psychoactive substance use, unspecified with psychoactive substance-induced psychotic disorder with hallucinations
HCC (V28): HCC 135 — Drug Use with Psychotic Complications
RAF: 0.424
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 135, Drug Use with Psychotic Complications

0.424

V24HCC 54, Substance Use with Psychotic Complications

0.329

ESRDHCC 54, Substance Use with Psychotic Complications

0.111

Each model's RAF is its CMS base weight for that model's standard population, so 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 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.

Work F19.951 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

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.

Coder workflow notes

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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 Use with Psychotic Complications (HCC 135) with a community, non-dual, aged base RAF weight of 0.424. Under the older CMS-HCC V24 model, F19.951 maps to Substance Use with Psychotic Complications (HCC 54) with a community, non-dual, aged base RAF weight of 0.329. 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