F55.1 — Abuse of herbal or folk remedies
F55.1 is a billable, specific ICD-10-CM code for abuse of herbal or folk remedies. It is valid for submission on a claim.
Risk adjustment
F55.1 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.
Medicare coverage
F55.1 is named in 18 Medicare coverage policies — 16 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
- A56865Billing and Coding: Psychiatric Inpatient Hospitalizationnot covered
- A54799Billing and Coding: Urine Drug Testing
- A55001Billing and Coding: Urine Drug Testing
How F55.1 is indexed
Coders do not find codes by browsing the tabular list — they look them up in the alphabetic index, under the word the physician wrote. These are the index entries that lead here, so you can see which chart wordings map to F55.1.
- Abuse›herbal or folk remedies
- Abuse›drug NEC›herbal or folk remedies
- Abuse›non-psychoactive substance NEC›folk remedies
- Abuse›non-psychoactive substance NEC›herbal remedies
Related codes at this level
Codes that share F55. If F55.1 is not quite right, the correct code is usually one of these.
Questions about F55.1
- Is F55.1 a billable ICD-10-CM code?
- Yes. F55.1 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does F55.1 sit in the tabular list?
- Mental, Behavioral and Neurodevelopmental disorders (F01-F99), in the block Behavioral syndromes associated with physiological disturbances and physical factors (F50-F59).