F16.19: Hallucinogen abuse with unspecified hallucinogen-induced disorder

Risk adjustment

F16.19 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:

• HCC 137 Drug Use Disorder, Moderate/Severe, or Drug Use with Non-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. Look up the whole chart to see which of its HCCs the hierarchy would zero.

Medicare coverage

F16.19 is named in 12 Medicare coverage policies: 10 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
• A56645Billing and Coding: Controlled Substance Monitoring and Drugs of Abuse Testing
• A56756Billing and Coding: Home Health - Psychiatric Care