F12.21
BillableCannabis dependence, in remission
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F12.21 an HCC code?
Yes. F12.21 maps to Drug Use Disorder/Substance Use Disorder, Moderate/Severe 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 F12.21
For F12.21 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 F12.21 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F12.21 is the ICD-10-CM diagnosis code for cannabis dependence, in remission. A person who was previously dependent on cannabis but is now in recovery and not currently using the drug. F12.21 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, F12.21 maps to Drug Use Disorder/Substance Use Disorder, Moderate/Severe (HCC 137) with a community, non-dual, aged base RAF weight of 0.358. Under the older CMS-HCC V24 model, F12.21 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.
Remission indicates the patient is no longer actively using cannabis; document the length of remission if available. Because F12.21 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 F12.21 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Remission indicates the patient is no longer actively using cannabis; document the length of remission if available
- •This code should only be used when there is clear evidence the patient has stopped cannabis use
Clinical Significance
Cannabis dependence in remission documents a history of cannabis dependence with successful cessation of use. This is clinically significant because it recognizes that dependence is a chronic condition that requires ongoing monitoring even during periods of abstinence. Relapse risk remains elevated, and the diagnosis supports continued engagement with treatment services. For risk adjustment, this code still captures the chronic nature of the substance use disorder.
Documentation Requirements
- ✓History of cannabis dependence meeting clinical criteria
- ✓Documentation of current abstinence from cannabis use
- ✓Duration of remission if available (early remission vs. sustained remission)
- ✓Ongoing treatment or monitoring plan
- ✓Provider statement confirming the patient is in remission