F16.99 — Hallucinogen use, unspecified with unspecified hallucinogen-induced disorder

Risk adjustment

F16.99 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.

Medicare coverage

F16.99 is named in 10 Medicare coverage policies — 8 listing it as supporting medical necessity, and 2 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
• 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