F10.21
BillableAlcohol dependence, in remission
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F10.21 an HCC code?
Yes. F10.21 maps to Alcohol Use Disorder under the CMS-HCC V28 risk adjustment model (and Drug/Alcohol Dependence under V24).
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.
MEAT Criteria for F10.21
For F10.21 to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically — it has to be re-documented and supported each calendar year.
- MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
- EEvaluate: test results, medication response, or physical findings reviewed by the provider
- AAssess: explicit mention in the assessment or plan with acknowledgment of status
- TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis
Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed F10.21 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F10.21 is the ICD-10-CM diagnosis code for alcohol dependence, in remission. A person who was dependent on alcohol but is now in remission, meaning they have stopped drinking or significantly reduced their alcohol use and are maintaining recovery. F10.21 sits in the ICD-10-CM chapter for mental, behavioral and neurodevelopmental disorders (f01-f99), within the section covering mental and behavioral disorders due to psychoactive substance use (f10-f19).
Under the CMS-HCC V28 risk adjustment model, F10.21 maps to Alcohol Use Disorder (HCC 139) with a community, non-dual, aged base RAF weight of 0.584. Under the older CMS-HCC V24 model, F10.21 maps to Drug/Alcohol Dependence (HCC 55) with a community, non-dual, aged base RAF weight of 0.334. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.
Document the length of remission (early or sustained) if available, though this level of specificity may require additional codes. Because F10.21 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for F10.21 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document the length of remission (early or sustained) if available, though this level of specificity may require additional codes
- •Ensure documentation confirms the patient is not currently using alcohol or is in a controlled recovery state
Clinical Significance
This code captures alcohol dependence currently in remission, documenting a history of alcohol dependence where the patient is not actively using or meeting criteria for active dependence. Remission status is important for ongoing monitoring, relapse prevention planning, and medication management. This code still carries risk adjustment weight because patients in remission require continued care coordination and monitoring.
Documentation Requirements
- ✓Documentation of alcohol dependence with at least three of: tolerance, withdrawal, use in larger amounts/longer periods than intended, persistent desire or unsuccessful efforts to cut down, significant time spent obtaining/using/recovering, important activities given up, continued use despite knowledge of physical/psychological problems
- ✓Documentation of remission status — specify early remission (3-12 months) or sustained remission (12+ months) if possible
- ✓Assessment and plan addressing alcohol use disorder with treatment recommendations (counseling, medication-assisted treatment, referral, etc.)