2027 ICD-10-CM Diagnosis Code F19.130Other psychoactive substance abuse with withdrawal, uncomplicated
ICD-10-CM Codes›F01–F99›F10-F19›F19
- Billable — Valid for Submission
- CC — Complication or Comorbidity
- Risk Adjusts — HCC 137
- Chronic Condition
F19.130 is a billable ICD-10-CM diagnosis code for other psychoactive substance abuse with withdrawal, uncomplicated. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 791, 793, 894 through 897. As a secondary diagnosis, it counts as a complication or comorbidity (CC) and moves an inpatient stay to a higher severity level within its MS-DRG family. It does not count, however, when the principal diagnosis is one of 458 closely related codes. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Other specified substance-related disorders.
For Medicare Advantage risk adjustment, F19.130 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
F19.130 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 F19.130: 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
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 F19.130, its category, or a range that includes it.
Excludes1 2
These codes carry an Excludes1 note naming F19.130: they are not reported together with it, unless the two conditions are unrelated.
Excludes2 2
These codes carry an Excludes2 note naming F19.130: 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.
Code History & ChangesHistory
Replacement F19.130 replaces the following previously assigned code(s):
- F19.188 - Oth psychoactive substance abuse w oth disorder
Questions About F19.130Overview
What is the ICD-10 code for other psychoactive substance abuse with withdrawal, uncomplicated?
The ICD-10-CM code for other psychoactive substance abuse with withdrawal, uncomplicated is F19.130 (sometimes written as F19130). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
Is F19.130 (Other psychoactive substance abuse with withdrawal) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report other psychoactive substance abuse with withdrawal, uncomplicated on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What MS-DRG does F19.130 group to?
When other psychoactive substance abuse with withdrawal, uncomplicated is the principal diagnosis on an inpatient stay, it groups to MS-DRG 793, 791, 894, 897, 895, 896, with relative weights from 0.6272 to 4.2192 depending on complications. Higher weights mean higher Medicare reimbursement.
Is F19.130 a CC or MCC?
CMS lists F19.130 as a CC (complication or comorbidity) for FY 2027. Reported as a secondary diagnosis, it moves the inpatient stay to a higher-weighted DRG within its severity family. It does not count when the principal diagnosis is one of the 458 closely related codes in its exclusion list.
Can F19.130 be reported with a code from F19.2?
Not as a rule. The Excludes1 note at F19.1, which applies to F19.130, 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 HCC is F19.130?
F19.130 (other psychoactive substance abuse with withdrawal, 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 F19.130 risk-adjust for Medicare Advantage payment?
Yes. When documented and reported on a Medicare Advantage encounter, F19.130 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.
