What is ICD-10 code F19.96?

F19.96 is the ICD-10-CM diagnosis code for Other psychoactive substance use, unspecified with psychoactive substance-induced persisting amnestic disorder. A long-lasting memory disorder where someone has difficulty forming or recalling new memories as a lasting effect of psychoactive substance use. F19.96 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. F19.96 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. F19.96 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. F19.96 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.

Which HCC does F19.96 map to under V28?

F19.96 maps to CMS-HCC V28 135 (Drug Use with Psychotic Complications). The category number and label come from the CMS-HCC V28 model file for payment year 2026.

What does F19.96 pay in RAF?

F19.96 carries a community, non-dual, aged (CNA) RAF weight of 0.424 under CMS-HCC V28 for payment year 2026. The weight comes from the CMS V28 relative-factor file, not a hand-typed table.

What is the V28 vs V24 difference for F19.96?

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 F19.96, 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.

2026 ICD-10-CM F19.96: Other psychoactive

F19.96 maps to CMS-HCC V28 135 (RAF 0.424). Documentation must support MEAT. MEAT criteria · RAF calculator · HCC Buddy coding tools

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Code lookupF19.96Effective 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)

F19.96

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

Other psychoactive substance use, unspecified with psychoactive substance-induced persisting amnestic disorder

A long-lasting memory disorder where someone has difficulty forming or recalling new memories as a lasting effect of psychoactive substance use.

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

F19Other psychoactive substance related disorders

F19.9Other psychoactive substance use, unspecified

F19.96Other psychoactive substance use, unspecified with psychoactive substance-induced persisting amnestic disorder

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for F19.96 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for F19.96 in this effective period.

Related Child Codes

Official

F19.90Other psychoactive substance use, unspecified, uncomplicated

F19.91Other psychoactive substance use, unspecified, in remission

F19.92Other psychoactive substance use, unspecified with intoxication

F19.93Other psychoactive substance use, unspecified with withdrawal

F19.94Other psychoactive substance use, unspecified with psychoactive substance-induced mood disorder

Includes

Official

ICD-10-CM does not list Includes notes for F19.96 in this effective period.

Excludes 1

Official

other psychoactive substance abuse (F19.1-)
other psychoactive substance dependence (F19.2-)

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for F19.96 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for F19.96 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for F19.96 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Documentation of current or historical psychoactive substance use

Neuropsychological assessment or cognitive testing demonstrating memory impairment

Provider determination that amnestic disorder is substance-induced and persisting beyond active use

Description of specific memory deficits (anterograde amnesia, retrograde amnesia, confabulation)

MEAT Support

HCC Buddy guidance

Documentation of current or historical psychoactive substance use

Neuropsychological assessment or cognitive testing demonstrating memory impairment

Provider determination that amnestic disorder is substance-induced and persisting beyond active use

Description of specific memory deficits (anterograde amnesia, retrograde amnesia, confabulation)

Audit Caution

HCC Buddy guidance

Coding non-specific amnesia (R41.3) when documentation establishes a substance-induced etiology

Confusing persisting amnestic disorder with transient memory effects during intoxication or withdrawal

Missing the 'persisting' qualifier — this condition continues after substance cessation, distinguishing it from acute effects

Using dementia codes (F19.97) when the impairment is specifically limited to memory function

Common Mistakes

HCC Buddy guidance

F10.96 — ALCOHOL-induced persisting amnestic disorder (Korsakoff syndrome); use when alcohol is the specific substance

F19.97 — Substance-induced persisting DEMENTIA is broader cognitive decline, not limited to memory

R41.3 — Other amnesia is a symptom code; use F19.96 when the substance-induced etiology is established

F04 — Amnestic disorder due to known physiological condition; use for non-substance causes

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 F19.96 an HCC code?

Yes. F19.96 (Other psychoactive substance use, unspecified with psychoactive substance-induced persisting amnestic disorder) 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: F19.96 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: F19.96
Description: Other psychoactive substance use, unspecified with psychoactive substance-induced persisting amnestic disorder
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 F19.96 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for F19.96

For F19.96 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 F19.96 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

F19.96 is the ICD-10-CM diagnosis code for other psychoactive substance use, unspecified with psychoactive substance-induced persisting amnestic disorder. A long-lasting memory disorder where someone has difficulty forming or recalling new memories as a lasting effect of psychoactive substance use. F19.96 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, F19.96 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, F19.96 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.

This code indicates a persisting condition that continues even after substance use stops. Because F19.96 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 F19.96 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•This code indicates a persisting condition that continues even after substance use stops
•Document the severity and functional impact of the memory impairment

Clinical Significance

Other psychoactive substance use, unspecified with substance-induced persisting amnestic disorder represents a permanent or long-lasting memory impairment caused by substance use that continues even after the substance is discontinued. This is a serious neurological consequence of substance abuse, analogous to Korsakoff syndrome seen with alcohol. The 'persisting' designation indicates this is not a transient effect but a lasting cognitive deficit requiring ongoing care.

Documentation Requirements

✓Documentation of current or historical psychoactive substance use
✓Neuropsychological assessment or cognitive testing demonstrating memory impairment
✓Provider determination that amnestic disorder is substance-induced and persisting beyond active use
✓Description of specific memory deficits (anterograde amnesia, retrograde amnesia, confabulation)
✓Functional impact assessment on activities of daily living
✓Neuroimaging findings if available (brain atrophy, white matter changes)

Commonly Confused Codes

•F10.96: ALCOHOL-induced persisting amnestic disorder (Korsakoff syndrome); use when alcohol is the specific substance
•F19.97: Substance-induced persisting DEMENTIA is broader cognitive decline, not limited to memory
•R41.3: Other amnesia is a symptom code; use F19.96 when the substance-induced etiology is established
•F04: Amnestic disorder due to known physiological condition; use for non-substance causes
•G31.2: Degeneration of nervous system due to alcohol; different classification for neurological damage