What is ICD-10 code F19.99?

F19.99 is the ICD-10-CM diagnosis code for Other psychoactive substance use, unspecified with unspecified psychoactive substance-induced disorder. A mental or behavioral disorder caused by psychoactive substance use where the specific type of disorder is not clearly documented or specified. F19.99 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. F19.99 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. F19.99 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. F19.99 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 F19.99 map to under V28?

F19.99 maps to CMS-HCC V28 HCC 137 (Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications). The category numbers, labels, and conditions come from the CMS-HCC V28 model file for payment year 2026.

2026 ICD-10-CM F19.99: Other psychoactive

F19.99 maps to CMS-HCC V28 137. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · HCC Buddy coding tools

ICD-10-CM Code View

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Code lookupF19.99

Effective 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)

F19.99

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

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

A mental or behavioral disorder caused by psychoactive substance use where the specific type of disorder is not clearly documented or specified.

Buddy Insight

Other psychoactive substance use, unspecified with unspecified substance-induced disorder is the least specific code in the F19.

Overview Risk Models Code Book Documentation Audit Notes Edition comparison

CMS-HCC V28

Mapped

HCC 137

Drug Use Disorder, Moderate/S...

Code-level coefficient reference

CMS-HCC V24

Historical

Not used for standard CY2026 Medicare Advantage payment. Select a historical period to review V24.

Not used for CY2026 payment

ACA/HHS

Mapped

HCC 082

HHS-HCC 082 adult, RAF varies...

Code-level coefficient reference

ESRD/PACE

Mapped

HCC 55

Substance Use Disorder/Modera...

Code-level coefficient reference

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 F19.99Other psychoactive substance use, unspecified with unspecified psychoactive substance-induced disorder

Inclusion Terms

Official

No inclusion terms are included in this display for F19.99. Check the code and parent instructions in the Code Book.

Excludes 2

Official

symptoms, signs and abnormal clinical laboratory findings, not elsewhere classified (R00-R99)Inherited from F01-F99

Related 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

disorders of psychological developmentInherited from F01-F99, F19
polysubstance drug use (indiscriminate drug use)Inherited from F01-F99, F19

Excludes 1

Official

other psychoactive substance abuse (F19.1-)Inherited from F19.9
other psychoactive substance dependence (F19.2-)Inherited from F19.9

Code First

Official

No Code First sequencing instructions are included in this display for F19.99. Check the code and parent instructions in the Code Book.

Use Additional

Official

No Use Additional Code instructions are included in this display for F19.99. Check the code and parent instructions in the Code Book.

Code Also

Official

No Code Also instructions are included in this display for F19.99. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance

Documentation of psychoactive substance use with some induced disorder present

Attempt to identify the specific substance(s) through provider query

Attempt to specify the use pattern (use, abuse, or dependence) through provider query

Attempt to identify the specific induced disorder through provider query

MEAT Support

HCC Buddy guidance

Documentation of psychoactive substance use with some induced disorder present

Attempt to identify the specific substance(s) through provider query

Attempt to specify the use pattern (use, abuse, or dependence) through provider query

Attempt to identify the specific induced disorder through provider query

Audit Caution

HCC Buddy guidance

Accepting this maximally unspecified code without exhausting all documentation review and provider query options

Not recognizing that more specific codes may carry higher HCC values (e.g., psychosis codes map to HCC 54 vs. HCC 55)

Using this code when the chart contains sufficient detail to support a more specific F19 code

Confusing F19.99 (with an induced disorder) with F19.9 (without any specified induced disorder or complication)

Common Mistakes

HCC Buddy guidance

F19.988 — OTHER specified substance-induced disorder when the disorder IS known but lacks a specific code

F19.9 — Substance use, unspecified (no induced disorder) is different from F19.99 which includes an induced disorder

F19.20 — Substance DEPENDENCE, uncomplicated should be used when dependence criteria and no induced disorder are documented

F19.29 — Substance DEPENDENCE with unspecified induced disorder; at least the dependence pattern is specified

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 F19.99 an HCC code?

Yes. F19.99 (Other psychoactive substance use, unspecified with unspecified psychoactive substance-induced disorder) maps to HCC 137, Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.424. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.

Coder answer: F19.99 is billable and maps to V28 HCC 137, Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code: F19.99
Description: Other psychoactive substance use, unspecified with unspecified psychoactive substance-induced disorder
HCC (V28): HCC 137 — Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications
RAF reference coefficient: 0.424
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 137, Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications

0.424

ESRDHCC 55, Substance Use Disorder/Moderate/Severe/Substance Use with Complications

Not separately weighted

These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. 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 context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.

Work F19.99 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for F19.99

For F19.99, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.

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

Coder workflow notes

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What This Code Means

F19.99 is the ICD-10-CM diagnosis code for other psychoactive substance use, unspecified with unspecified psychoactive substance-induced disorder. A mental or behavioral disorder caused by psychoactive substance use where the specific type of disorder is not clearly documented or specified. F19.99 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, F19.99 maps to Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications (HCC 137) with a source-labeled community, non-dual, aged reference coefficient of 0.424. No V24 mapping is shown for F19.99; use the applicable model and payment year when reviewing the V28 mapping. For CY2026 non-PACE Medicare Advantage, CMS uses 100% of the 2024 CMS-HCC model (V28). PACE uses a separate model blend. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.

This is a last-resort code; attempt to identify the specific substance-induced disorder when possible. For F19.99, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule. 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, source-labeled coefficient references, and MEAT documentation criteria for F19.99 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•This is a last-resort code; attempt to identify the specific substance-induced disorder when possible
•Request clarification from the provider about the nature of the substance-induced condition

Clinical Significance

Other psychoactive substance use, unspecified with unspecified substance-induced disorder is the least specific code in the F19.9X range, indicating both the substance use pattern and the induced disorder type are unspecified. While it still captures an HCC, it represents a significant documentation gap. This code should prompt aggressive provider querying to identify the specific substances used, the pattern of use (abuse vs. dependence), and the nature of the induced disorder.

Documentation Requirements

✓Documentation of psychoactive substance use with some induced disorder present
✓Attempt to identify the specific substance(s) through provider query
✓Attempt to specify the use pattern (use, abuse, or dependence) through provider query
✓Attempt to identify the specific induced disorder through provider query
✓Any available clinical details about the substance-related condition
✓Treatment plan documentation

Commonly Confused Codes

•F19.988: OTHER specified substance-induced disorder when the disorder IS known but lacks a specific code
•F19.9: Substance use, unspecified (no induced disorder) is different from F19.99 which includes an induced disorder
•F19.20: Substance DEPENDENCE, uncomplicated should be used when dependence criteria and no induced disorder are documented
•F19.29: Substance DEPENDENCE with unspecified induced disorder; at least the dependence pattern is specified