F19.988
BillableOther psychoactive substance use, unspecified with other psychoactive substance-induced disorder
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F19.988 an HCC code?
Yes. F19.988 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 F19.988
For F19.988to 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 F19.988 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F19.988 is the ICD-10-CM diagnosis code for other psychoactive substance use, unspecified with other psychoactive substance-induced disorder. Other mental or behavioral problems caused by psychoactive substance use that don't fit into the more specific categories listed above. F19.988 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, F19.988 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, F19.988 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.
Use this code only when the specific substance-induced disorder is not captured by other F19 codes. Because F19.988 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 F19.988 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 substance-induced disorder is not captured by other F19 codes
- •Document the specific disorder in clinical notes for clarity
Clinical Significance
Other psychoactive substance use, unspecified with other substance-induced disorder is a residual code for substance-induced conditions that do not fit the specific categories (anxiety, sexual dysfunction, sleep, mood, psychosis). This might include substance-induced movement disorders, obsessive-compulsive disorders, or other neurobehavioral syndromes. Capturing this code ensures risk adjustment accounts for the full spectrum of substance-related complications.
Documentation Requirements
- ✓Documentation of current psychoactive substance use
- ✓Description of the specific induced disorder that does not fit standard categories
- ✓Provider determination that the disorder is causally related to substance use
- ✓Temporal relationship between substance use and onset of the disorder
- ✓Confirmation that the disorder does not fit F19.980-F19.982, F19.94, or F19.950-F19.959 categories
- ✓Treatment plan addressing both conditions
Commonly Confused Codes
- •F19.980 — Use for substance-induced ANXIETY specifically
- •F19.981 — Use for substance-induced SEXUAL DYSFUNCTION specifically
- •F19.982 — Use for substance-induced SLEEP DISORDER specifically
- •F19.99 — UNSPECIFIED substance-induced disorder when the specific disorder is unknown; F19.988 is for known disorders without a specific code
- •F19.94 — Use for substance-induced MOOD DISORDER specifically