F19.96 — Other psychoactive substance use, unspecified with psychoactive substance-induced persisting amnestic disorder

Risk adjustment

F19.96 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

F19.96 is named in 12 Medicare coverage policies — 11 listing it as supporting medical necessity, and 1 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
• A56645Billing and Coding: Controlled Substance Monitoring and Drugs of Abuse Testing
• A56756Billing and Coding: Home Health - Psychiatric Care
• A56767Billing and Coding: Heavy Metal Testing