2027 ICD-10-CM Diagnosis Code F16.10Hallucinogen abuse, uncomplicated
ICD-10-CM Codes›F01–F99›F10-F19›F16
- Billable — Valid for Submission
- Risk Adjusts — HCC 138
- Chronic Condition
F16.10 is a billable ICD-10-CM diagnosis code for hallucinogen abuse, uncomplicated. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 894 through 897. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Hallucinogen-related disorders.
For Medicare Advantage risk adjustment, F16.10 maps to CMS-HCC Category 138 (Drug Use Disorder, Mild, Uncomplicated, Except Cannabis) under the V28 model, adding a risk factor of about 0.423 for a community, non-dual, aged beneficiary in payment year 2027.
Code Identity
Code Classification
Medicare Risk Adjustment (HCC)Billing
F16.10 maps to a payment category in the CMS-HCC model used to risk-adjust Medicare Advantage payments. Weights are the published community factors for payment year 2027.
Source: CMS Payment Year 2027 risk adjustment mappings and model software. Weights are relative factors, not dollar amounts; a beneficiary's total RAF also includes demographics and interactions. Browse all CMS-HCC categories.
Approximate SynonymsGuidance
Alternate terms and clinical phrases that map to this code.
- Continuous nondependent harmful pattern of use of hallucinogen
- Episode of harmful use of hallucinogen
- Episode of harmful use of ketamine
- Episode of harmful use of phencyclidine
- Episodic harmful pattern of use of phencyclidine
- Episodic nondependent harmful pattern of use of hallucinogen
- Harmful pattern of use of hallucinogen
- Harmful pattern of use of ketamine
- Harmful pattern of use of phencyclidine
- Ketamine use disorder
- Nondependent harmful pattern of use of hallucinogen
- Nondependent harmful pattern of use of hallucinogen in remission
- Phencyclidine use disorder
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to F16.10: its own notes plus those printed at F16.1, F16, and Chapter 5. A note printed at a category, block or chapter applies to every code under it.
Includes
Further defines, or gives examples of, the content of the category.
- ecstasy
- PCP
- phencyclidine
- disorders of psychological development
Applicable To
Conditions this code is used for: synonyms of the title or, for "other specified" codes, the conditions assigned to it. The list is not exhaustive.
- Other hallucinogen use disorder, mild
- Phencyclidine use disorder, mild
Excludes1
Not coded here: the excluded code is never reported together with this one, unless the two conditions are unrelated.
Excludes2
Not included here: the excluded condition is not part of this code, but a patient may have both, so both codes may be reported.
Source: CMS ICD-10-CM Tabular List. How to read instructional notes.
Referenced in Other NotesGuidance
Instructional notes printed at other codes that name F16.10, its category, or a range that includes it.
Excludes1 2
These codes carry an Excludes1 note naming F16.10: they are not reported together with it, unless the two conditions are unrelated.
Index to Diseases and InjuriesGuidance
Alphabetical index entries that point to this code.
Disorder (of) See Also: Disease;
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Patient EducationClinical
Drug Use and Addiction
Drugs are chemical substances that can change how your body and mind work. They include prescription medicines, over-the-counter medicines, alcohol, tobacco, and illegal drugs.
The full article covers:
- What are drugs?
- What is drug use?
- What is drug addiction?
- Does everyone who takes drugs become addicted?
- Who is at risk for drug addiction?
- What are the signs that someone has a drug problem?
- What are the treatments for drug addiction?
- Can drug use and addiction be prevented?
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Convert F16.10 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About F16.10Overview
What is the ICD-10 code for hallucinogen abuse, uncomplicated?
The ICD-10-CM code for hallucinogen abuse, uncomplicated is F16.10 (sometimes written as F1610). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
Is F16.10 (Hallucinogen abuse) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report hallucinogen abuse, uncomplicated on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What MS-DRG does F16.10 group to?
When hallucinogen abuse, uncomplicated is the principal diagnosis on an inpatient stay, it groups to MS-DRG 894, 897, 895, 896, with relative weights from 0.6272 to 1.6610 depending on complications. Higher weights mean higher Medicare reimbursement.
Can F16.10 be reported with a code from F16.2?
Not as a rule. The Excludes1 note at F16.1, which applies to F16.10, lists "hallucinogen dependence (F16.2-)". An Excludes1 note means the excluded code is never reported together with this one; the only exception is when the two conditions are unrelated to each other (Official Guidelines, Section I.A.12.a).
What is the ICD-9 equivalent of F16.10?
Under the General Equivalence Mappings, hallucinogen abuse, uncomplicated converts to ICD-9-CM 305.30 (hallucinog abuse-unspec), 305.31 (hallucinog abuse-contin), and 305.32 (hallucinog abuse-episod). The mapping is approximate, so confirm the match fits the documentation.
What HCC is F16.10?
F16.10 (hallucinogen abuse, uncomplicated) maps to CMS-HCC Category 138 (Drug Use Disorder, Mild, Uncomplicated, Except Cannabis), commonly written as HCC 138, in the CMS-HCC V28 model used for Medicare Advantage risk adjustment in payment year 2027. It mapped to HCC 56 under the retired V24 model. It also maps in the ESRD (V24) model. It does not map to any RxHCC in the Part D prescription drug model.
Does F16.10 risk-adjust for Medicare Advantage payment?
Yes. When documented and reported on a Medicare Advantage encounter, F16.10 adds a risk adjustment factor of about 0.423 to the beneficiary's RAF score for a community, non-dual, aged enrollee (published V28 weights range from 0.264 to 0.502 depending on the payment segment). A more severe related category (HCC 135, HCC 136, and HCC 137) supersedes it when both are reported. See the full factor table on the HCC 138 category page.
