ICD-10 F12.259
Billable / Specific HCC v28: 54Cannabis dependence with psychotic disorder, unspecified
About ICD-10-CM F12.259
ICD-10-CM code F12.259 represents Cannabis dependence with psychotic disorder, unspecified. This is a billable/specific code in the Mental, Behavioral, and Neurodevelopmental chapter (block F12). The 2026 edition of ICD-10-CM F12.259 became effective on October 1, 2025.
Coding Tips for F12.259
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
F12.259 is a CMS-HCC v28 risk-adjustment code (category 54). 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
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 F12.259
Local Coverage Determinations (LCDs) from CMS MACs that list F12.259 as a covered diagnosis.
Showing top 10 of 329 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing F12.259.
1 Cigna
5 Medicare
Convert F12.259 to ICD-9-CM
Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.
| ICD-10 | ICD-9 | Mapping Flags |
|---|---|---|
| F12.259 | 29289 | 10111 |
| F12.259 | 30430 | 10112 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To F12.259
Other codes in section F10-F19 (Mental and behavioral disorders due to psychoactive substance use).
ICD-10 F12.259, Billing FAQ
Is ICD-10 code F12.259 billable? +
Yes, F12.259 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
Does F12.259 affect Medicare Advantage HCC risk adjustment? +
Yes. F12.259 maps to CMS-HCC v28 category 54. Capture this diagnosis annually for accurate Medicare Advantage risk score.
What CPT codes are commonly billed with F12.259? +
Procedures frequently paired with F12.259 include: 90875, 90876.
What ICD-9 codes does F12.259 map to? +
Per CMS GEMs, F12.259 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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