2027 ICD-10-CM Diagnosis Code F16.11Hallucinogen abuse, in remission
ICD-10-CM Codes›F01–F99›F10-F19›F16
- Billable — Valid for Submission
- Risk Adjusts — HCC 138
- Chronic Condition
F16.11 is a billable ICD-10-CM diagnosis code for hallucinogen abuse, in remission. 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. Coders also document this condition as history of hallucinogen abuse. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Mental and substance use disorders in remission.
For Medicare Advantage risk adjustment, F16.11 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
F16.11 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.
- History of hallucinogen abuse
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to F16.11: 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, in early remission
- Other hallucinogen use disorder, mild, in sustained remission
- Phencyclidine use disorder, mild, in early remission
- Phencyclidine use disorder, mild, in sustained remission
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 F16.11, its category, or a range that includes it.
Excludes1 2
These codes carry an Excludes1 note naming F16.11: 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.
Convert F16.11 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code History & ChangesHistory
Replacement F16.11 replaces the following previously assigned code(s):
- F16.10 - Hallucinogen abuse, uncomplicated
Questions About F16.11Overview
What is the ICD-10 code for hallucinogen abuse, in remission?
The ICD-10-CM code for hallucinogen abuse, in remission is F16.11 (sometimes written as F1611). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
Is F16.11 (Hallucinogen abuse) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report hallucinogen abuse, in remission on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What MS-DRG does F16.11 group to?
When hallucinogen abuse, in remission 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 F16.11 be reported with a code from F16.2?
Not as a rule. The Excludes1 note at F16.1, which applies to F16.11, 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 F16.11?
Under the General Equivalence Mappings, hallucinogen abuse, in remission converts to ICD-9-CM 305.33 (hallucinog abuse-remiss). The mapping is a direct match.
What HCC is F16.11?
F16.11 (hallucinogen abuse, in remission) 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 F16.11 risk-adjust for Medicare Advantage payment?
Yes. When documented and reported on a Medicare Advantage encounter, F16.11 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.
