F19.981
BillableOther psychoactive substance use, unspecified with psychoactive substance-induced sexual dysfunction
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F19.981 an HCC code?
Yes. F19.981 maps to Drug Use Disorder/Substance Use Disorder, Moderate/Severe under the CMS-HCC V28 risk adjustment model (and Drug/Alcohol Dependence 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 F19.981
For F19.981to 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 F19.981 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F19.981 is the ICD-10-CM diagnosis code for other psychoactive substance use, unspecified with psychoactive substance-induced sexual dysfunction. Sexual dysfunction or problems with sexual performance or desire that develops directly from the use of various psychoactive substances. F19.981 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, F19.981 maps to Drug Use Disorder/Substance Use Disorder, Moderate/Severe (HCC 137) with a community, non-dual, aged base RAF weight of 0.358. Under the older CMS-HCC V24 model, F19.981 maps to Drug/Alcohol Dependence (HCC 55) with a community, non-dual, aged base RAF weight of 0.334. 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.
Document the specific type of sexual dysfunction when possible (erectile dysfunction, decreased libido, etc.). Because F19.981 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 F19.981 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document the specific type of sexual dysfunction when possible (erectile dysfunction, decreased libido, etc.)
- •Note whether the dysfunction resolves with abstinence from the substance
Clinical Significance
Other psychoactive substance use, unspecified with substance-induced sexual dysfunction captures sexual health problems directly caused by substance use. Many psychoactive substances affect sexual function through neurological, hormonal, or vascular mechanisms. Documentation of this comorbidity reflects the multisystem impact of substance use and supports the complexity of care required. Accurate coding helps ensure appropriate risk adjustment for the comprehensive treatment these patients need.
Documentation Requirements
- ✓Documentation of current psychoactive substance use
- ✓Specific type of sexual dysfunction identified (erectile dysfunction, decreased libido, anorgasmia, delayed ejaculation)
- ✓Temporal relationship between substance use and sexual dysfunction onset
- ✓Provider determination that dysfunction is substance-induced rather than due to other medical conditions or medications
- ✓Assessment of whether dysfunction resolves with abstinence
- ✓Treatment plan documentation
Commonly Confused Codes
- •F19.281 — Substance DEPENDENCE with induced sexual dysfunction; use when dependence criteria are documented
- •F19.181 — Substance ABUSE with induced sexual dysfunction; use when abuse criteria are documented
- •N52.9 — Male erectile dysfunction, unspecified should be used for primary erectile dysfunction not related to substances
- •F52.0 — Hypoactive sexual desire disorder is a primary sexual dysfunction diagnosis
- •F52.21 — Male erectile disorder is primary, not substance-induced