F12.959 — Cannabis use, unspecified with psychotic disorder, unspecified

Risk adjustment

F12.959 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:

• HCC 135 Drug Use with Psychotic Complications0.424 RAF

Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score.

Medicare coverage

F12.959 is named in 15 Medicare coverage policies — 12 listing it as supporting medical necessity, and 3 listing it as NOT covered. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.

• A52434Health and Behavior Assessment/Intervention – Medical Policy Articlenot covered
• A56562Billing and Coding: Health and Behavior Assessment/Interventionnot covered
• A59718Billing and Coding: Opioid Treatment Programsnot covered
• A56614Billing and Coding: Psychiatric Inpatient Hospitalization