2027 ICD-10-CM Diagnosis Code F19.11Other psychoactive substance abuse, in remission
ICD-10-CM Codes›F01–F99›F10-F19›F19
- Billable — Valid for Submission
- Risk Adjusts — HCC 138
- Chronic Condition
F19.11 is a billable ICD-10-CM diagnosis code for other psychoactive substance 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 harmful pattern of substance use in remission. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Mental and substance use disorders in remission.
For Medicare Advantage risk adjustment, F19.11 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
F19.11 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.
- Harmful pattern of substance use in remission
- Harmful pattern of use of antidepressant
- History of intravenous drug abuse
- History of laxative abuse
- Nondependent harmful pattern of mixed substance use
- Nondependent harmful pattern of mixed substance use in remission
- Nondependent harmful pattern of use of antidepressant in remission
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to F19.11: its own notes plus those printed at F19.1, F19, 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.
- polysubstance drug use (indiscriminate drug use)
- 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 (or unknown) substance use disorder, mild, in early remission
- Other (or unknown) substance 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 F19.11, its category, or a range that includes it.
Excludes1 2
These codes carry an Excludes1 note naming F19.11: they are not reported together with it, unless the two conditions are unrelated.
Excludes2 2
These codes carry an Excludes2 note naming F19.11: its condition is not part of those codes, and both may be reported when the patient has both.
- F44.0 Dissociative amnesiaalcohol-or other psychoactive substance-induced amnestic disorder (F10, F13, F19 with .26, .96) names F19, which includes this code
- T40 Poisoning by, adverse effect of and underdosing of narcotics and psychodysleptics [hallucinogens]drug dependence and related mental and behavioral disorders due to psychoactive substance use (F10.-F19.-) names F19.-, which includes this code
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.
Convert F19.11 to ICD-9-CMHistory
Code History & ChangesHistory
Replacement F19.11 replaces the following previously assigned code(s):
- F19.10 - Other psychoactive substance abuse, uncomplicated
Questions About F19.11Overview
What is the ICD-10 code for other psychoactive substance abuse, in remission?
The ICD-10-CM code for other psychoactive substance abuse, in remission is F19.11 (sometimes written as F1911). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
Is F19.11 (Other psychoactive substance abuse) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report other psychoactive substance abuse, in remission on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What MS-DRG does F19.11 group to?
When other psychoactive substance 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 F19.11 be reported with a code from F19.2?
Not as a rule. The Excludes1 note at F19.1, which applies to F19.11, lists "other psychoactive substance dependence (F19.2-)". 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 F19.11?
Under the General Equivalence Mappings, other psychoactive substance abuse, in remission converts to ICD-9-CM 305.83 (antidepress abuse-remiss) and 305.93 (drug abuse NEC-in remiss). The mapping is approximate, so confirm the match fits the documentation.
What HCC is F19.11?
F19.11 (other psychoactive substance 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 F19.11 risk-adjust for Medicare Advantage payment?
Yes. When documented and reported on a Medicare Advantage encounter, F19.11 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.
