2027 ICD-10-CM Diagnosis Code F16.120Hallucinogen abuse with intoxication, uncomplicated
ICD-10-CM Codes›F01–F99›F10-F19›F16
- Billable — Valid for Submission
- Risk Adjusts — HCC 137
- Chronic Condition
F16.120 is a billable ICD-10-CM diagnosis code for hallucinogen abuse with intoxication, 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, F16.120 maps to CMS-HCC Category 137 (Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications) under the V28 model, adding a risk factor of about 0.424 for a community, non-dual, aged beneficiary in payment year 2027.
Code Identity
Code Classification
Medicare Risk Adjustment (HCC)Billing
F16.120 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.
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to F16.120: 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
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 F16.120, its category, or a range that includes it.
Excludes1 2
These codes carry an Excludes1 note naming F16.120: 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.
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 F16.120 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About F16.120Overview
What is the ICD-10 code for hallucinogen abuse with intoxication, uncomplicated?
The ICD-10-CM code for hallucinogen abuse with intoxication, uncomplicated is F16.120 (sometimes written as F16120). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
Is F16.120 (Hallucinogen abuse with intoxication) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report hallucinogen abuse with intoxication, uncomplicated on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What MS-DRG does F16.120 group to?
When hallucinogen abuse with intoxication, 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 F16.120 be reported with a code from F16.2?
Not as a rule. The Excludes1 note at F16.1, which applies to F16.120, 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 F16.120?
Under the General Equivalence Mappings, hallucinogen abuse with intoxication, 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 F16.120?
F16.120 (hallucinogen abuse with intoxication, uncomplicated) maps to CMS-HCC Category 137 (Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications), commonly written as HCC 137, in the CMS-HCC V28 model used for Medicare Advantage risk adjustment in payment year 2027. It mapped to HCC 55 under the retired V24 model. It also maps in the PACE (CMS-HCC V22), ESRD (V21), and ESRD (V24) models. It does not map to any RxHCC in the Part D prescription drug model.
Does F16.120 risk-adjust for Medicare Advantage payment?
Yes. When documented and reported on a Medicare Advantage encounter, F16.120 adds a risk adjustment factor of about 0.424 to the beneficiary's RAF score for a community, non-dual, aged enrollee (published V28 weights range from 0.297 to 0.502 depending on the payment segment). A more severe related category (HCC 135 and HCC 136) supersedes it when both are reported. See the full factor table on the HCC 137 category page.
