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

ICD-10 F19.981

Billable / Specific HCC v28: 55

Other psychoactive substance use, unspecified with psychoactive substance-induced sexual dysfunction

F19
Block
1
Synonyms
218
LCDs
9
Payer Policies
0
Linked CPTs

About ICD-10-CM F19.981

ICD-10-CM code F19.981 represents Other psychoactive substance use, unspecified with psychoactive substance-induced sexual dysfunction. This is a billable/specific code in the Mental, Behavioral, and Neurodevelopmental chapter (block F19). The 2026 edition of ICD-10-CM F19.981 became effective on October 1, 2025.

Coding Tips for F19.981

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

HCC capture: document with MEAT each year

F19.981 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.

Inclusion Terms / Approximate Synonyms

Clinical terms and conditions classified under F19.981. Per CMS ICD-10-CM Tabular 2026.

  • Other (or unknown) substance-induced sexual dysfunction, without use disorder

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 F19.981

Local Coverage Determinations (LCDs) from CMS MACs that list F19.981 as a covered diagnosis.

218 LCDs

Showing top 10 of 218 total . Click a CPT for full coverage scope.

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 →
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 80305 →

Commercial Payer Coverage

Coverage policies from major commercial payers referencing F19.981.

9 policies

5 Medicare

Billing and Coding: Controlled Substance Monitoring and Drugs of Abuse Testing
Policy ID: ART-56645
Billing and Coding: Home Health - Psychiatric Care
Policy ID: ART-56756
Billing and Coding: Urine Drug Testing
Policy ID: ART-56818
Billing and Coding: Psychiatry and Psychology Services
Policy ID: ART-56937
Billing and Coding: Outpatient Psychiatry and Psychology Services
Policy ID: ART-57065

CPT Codes Commonly Billed with F19.981

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

No procedure linkages on file for F19.981

We don't have CPT pairings indexed for this specific code yet. Use the CPT search above to find common procedures, or check your payer's published medical policy for code-specific guidance.

Convert F19.981 to ICD-9-CM

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

ICD-10ICD-9Mapping Flags
F19.981 29289 10000

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

ICD-10 F19.981, Billing FAQ

Is ICD-10 code F19.981 billable? +

Yes, F19.981 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.

What other names or terms map to F19.981? +

ICD-10 F19.981 includes: Other (or unknown) substance-induced sexual dysfunction, without use disorder.

Does F19.981 affect Medicare Advantage HCC risk adjustment? +

Yes. F19.981 maps to CMS-HCC v28 category 55. Capture this diagnosis annually for accurate Medicare Advantage risk score.

What ICD-9 codes does F19.981 map to? +

Per CMS GEMs, F19.981 maps to ICD-9 codes: 29289. 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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