F19.959
BillableOther psychoactive substance use, unspecified with psychoactive substance-induced psychotic disorder, unspecified
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F19.959 an HCC code?
Yes. F19.959 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 F19.959
For F19.959 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 F19.959 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F19.959 is the ICD-10-CM diagnosis code for other psychoactive substance use, unspecified with psychoactive substance-induced psychotic disorder, unspecified. This code describes a patient who uses unspecified psychoactive substances (drugs or alcohol) and has developed psychotic symptoms like hallucinations or delusions as a direct result of that substance use. The specific substance and type of psychotic disorder are not identified. F19.959 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, F19.959 maps to Drug/Alcohol Psychosis (HCC 135) with a community, non-dual, aged base RAF weight of 0.000. Under the older V24 model, F19.959 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.
Use this code only when the specific psychoactive substance cannot be identified; if the substance is known (cocaine, cannabis, opioids, etc.), use the more specific F1X.959 code for that substance. Because F19.959 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 F19.959 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use this code only when the specific psychoactive substance cannot be identified; if the substance is known (cocaine, cannabis, opioids, etc.), use the more specific F1X.959 code for that substance
- •Ensure documentation clearly links the psychotic symptoms to active substance use rather than a primary psychotic disorder; if psychosis persists after substance cessation, a different diagnosis may be more appropriate
Clinical Significance
Other psychoactive substance use, unspecified with substance-induced psychotic disorder, unspecified captures a psychotic presentation caused by substance use where the specific psychotic features (delusions vs. hallucinations) are not documented. While less specific than F19.950 or F19.951, it still maps to the higher psychosis HCC. This code represents a documentation opportunity — querying the provider about the specific psychotic features would improve clinical data quality.
Documentation Requirements
- ✓Documentation of psychoactive substance use with temporal relationship to psychosis
- ✓Provider statement that psychotic symptoms are substance-induced
- ✓Attempt to clarify whether primary features are delusions, hallucinations, or both through provider query
- ✓Safety assessment and level of care determination
- ✓Psychiatric evaluation documentation
- ✓Treatment plan including psychotropic medications if used
Commonly Confused Codes
- •F19.950 — Use when DELUSIONS are the primary psychotic feature
- •F19.951 — Use when HALLUCINATIONS are the primary psychotic feature
- •F29 — Unspecified psychosis not due to substance; use only when substance etiology is ruled out
- •F19.929 — Intoxication, unspecified does NOT capture the psychotic disorder component
- •F19.99 — Unspecified substance-induced disorder is even less specific and misses the psychosis designation