F16.11

F16.11: Hallucinogen abuse, in remission

Billable / specific codeICD-10-CM

F16.11 is a billable, specific ICD-10-CM code for hallucinogen abuse, in remission. It is valid for submission on a claim.

Check F16.11 with the rest of the claim: free scrubber

Inclusion terms

Alternative wordings a physician may use in the chart for this same code.

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 inherited from the categories above F16.11

A category’s note binds every code beneath it.

Written on F16.1: Hallucinogen abuse

hallucinogen dependence (F16.2-)
hallucinogen use, unspecified (F16.9-)

Risk adjustment

F16.11 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:

HCC 138 Drug Use Disorder, Mild, Uncomplicated, Except Cannabis0.423 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. Look up the whole chart to see which of its HCCs the hierarchy would zero.

Medicare coverage

F16.11 is named in 13 Medicare coverage policies: 11 listing it as supporting medical necessity, and 2 listing it as NOT covered. Which one applies depends on your Medicare contractor.

A52434Health and Behavior Assessment/Intervention – Medical Policy Articlenot covered
A59718Billing and Coding: Opioid Treatment Programsnot covered
A54799Billing and Coding: Urine Drug Testing
A55001Billing and Coding: Urine Drug Testing

Alphabetic index entries that lead here

Abuse›drug NEC›hallucinogen›in remission(early) (sustained)
Disorder›hallucinogen use›mild›in remission(early) (sustained)
Disorder›phencyclidine use›mild›in remission(early) (sustained)

Code history

Unchanged in every release from FY2024 to FY2027.