ICD-10-CM 2026 · Effective October 1, 2025

ICD-10 F12.222

Billable / Specific HCC v28: 55

Cannabis dependence with intoxication with perceptual disturbance

F12
Block
0
Synonyms
363
LCDs
19
Payer Policies
26
Linked CPTs

About ICD-10-CM F12.222

ICD-10-CM code F12.222 represents Cannabis dependence with intoxication with perceptual disturbance. This is a billable/specific code in the Mental, Behavioral, and Neurodevelopmental chapter (block F12). The 2026 edition of ICD-10-CM F12.222 became effective on October 1, 2025.

Coding Tips for F12.222

Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.

HCC capture: document with MEAT each year

F12.222 is a CMS-HCC v28 risk-adjustment code (category 55). To count for the patient Risk Adjustment Factor (RAF), document the diagnosis with MEAT language each calendar year: Monitored, Evaluated, Assessed, Treated. A diagnosis on the problem list alone does not satisfy CMS RADV audit standards. Include the diagnosis in the assessment with current status and current treatment plan.

Medicare Advantage HCC Impact

CMS-HCC v28 (current)
Category 55
ESRD-HCC
Category 55
RxHCC (Part D)
Category 55

Capture this diagnosis annually for accurate risk adjustment. Missed HCC captures are the #1 revenue leak in Medicare Advantage risk programs.

Medicare LCD Coverage for F12.222

Local Coverage Determinations (LCDs) from CMS MACs that list F12.222 as a covered diagnosis.

363 LCDs

Showing top 10 of 363 total . Click a CPT for full coverage scope.

CMS LCD: Billing and Coding: Psychiatric Inpatient Hospitalization
Article ID: 57052, Effective: 2026-03-26 00:00:00, 422 covered, 0 non-covered
CPT XX000 →
CMS LCD: Billing and Coding: Home Health - Psychiatric Care
Article ID: 56756, Effective: 2023-11-09 00:00:00, 595 covered, 0 non-covered
CPT G0156 →
CMS LCD: Billing and Coding: Home Health - Psychiatric Care
Article ID: 56756, Effective: 2023-11-09 00:00:00, 595 covered, 0 non-covered
CPT G0299 →
CMS LCD: Billing and Coding: Home Health - Psychiatric Care
Article ID: 56756, Effective: 2023-11-09 00:00:00, 595 covered, 0 non-covered
CPT G0152 →
CMS LCD: Billing and Coding: Home Health - Psychiatric Care
Article ID: 56756, Effective: 2023-11-09 00:00:00, 595 covered, 0 non-covered
CPT G0155 →
CMS LCD: Billing and Coding: Home Health - Psychiatric Care
Article ID: 56756, Effective: 2023-11-09 00:00:00, 595 covered, 0 non-covered
CPT G0300 →
CMS LCD: Billing and Coding: Controlled Substance Monitoring and Drugs of Abuse Testing
Article ID: 56645, Effective: 2024-10-01 00:00:00, 1310 covered, 1 non-covered
CPT G0480 →
CMS LCD: Billing and Coding: Controlled Substance Monitoring and Drugs of Abuse Testing
Article ID: 56645, Effective: 2024-10-01 00:00:00, 1310 covered, 1 non-covered
CPT G0481 →
CMS LCD: Billing and Coding: Controlled Substance Monitoring and Drugs of Abuse Testing
Article ID: 56645, Effective: 2024-10-01 00:00:00, 1310 covered, 1 non-covered
CPT G0482 →
CMS LCD: Billing and Coding: Controlled Substance Monitoring and Drugs of Abuse Testing
Article ID: 56645, Effective: 2024-10-01 00:00:00, 1310 covered, 1 non-covered
CPT G0483 →

Commercial Payer Coverage

Coverage policies from major commercial payers referencing F12.222.

19 policies

1 Cigna

Anesthesia Services for Interventional Pain Management Procedures in an Adult - (0551)
Policy ID: MM_0551

5 Medicare

Billing and Coding: Psychiatric Inpatient Hospitalization
Policy ID: ART-56614
Billing and Coding: Controlled Substance Monitoring and Drugs of Abuse Testing
Policy ID: ART-56645
Billing and Coding: Partial Hospitalization Programs
Policy ID: ART-56685
Billing and Coding: Home Health - Psychiatric Care
Policy ID: ART-56756
Billing and Coding: Urine Drug Testing
Policy ID: ART-56818

CPT Codes Commonly Billed with F12.222

Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.

26 linkages
  • 96121 CMS LCD: Billing and Coding: Psychiatric Partial Hospitalization Programs CMS LCD
  • 96137 CMS LCD: Billing and Coding: Psychiatric Partial Hospitalization Programs CMS LCD
  • 96116 CMS LCD: Billing and Coding: Psychiatric Partial Hospitalization Programs CMS LCD
  • 96132 CMS LCD: Billing and Coding: Psychiatric Partial Hospitalization Programs CMS LCD
  • 90838 CMS LCD: Billing and Coding: Psychiatric Partial Hospitalization Programs CMS LCD
  • G0177 CMS LCD: Billing and Coding: Psychiatric Partial Hospitalization Programs CMS LCD
  • 96146 CMS LCD: Billing and Coding: Psychiatric Partial Hospitalization Programs CMS LCD
  • 90846 CMS LCD: Billing and Coding: Psychiatric Partial Hospitalization Programs CMS LCD
  • G0411 CMS LCD: Billing and Coding: Psychiatric Partial Hospitalization Programs CMS LCD
  • 96112 CMS LCD: Billing and Coding: Psychiatric Partial Hospitalization Programs CMS LCD

Convert F12.222 to ICD-9-CM

Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.

ICD-10ICD-9Mapping Flags
F12.222 29289 10111
F12.222 30430 10112

Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).

ICD-10 F12.222, Billing FAQ

Is ICD-10 code F12.222 billable? +

Yes, F12.222 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.

Does F12.222 affect Medicare Advantage HCC risk adjustment? +

Yes. F12.222 maps to CMS-HCC v28 category 55. Capture this diagnosis annually for accurate Medicare Advantage risk score.

What CPT codes are commonly billed with F12.222? +

Procedures frequently paired with F12.222 include: 96121, 96137, 96116, 96132, 90838.

What ICD-9 codes does F12.222 map to? +

Per CMS GEMs, F12.222 maps to ICD-9 codes: 29289, 30430. Useful for legacy data review and historical claim analysis.

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Reviewed by the PayerReady Medical Coding Team

Verified against the CMS 2026 code set on May 31, 2026.

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