F12.220
BillableCannabis dependence with intoxication, uncomplicated
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F12.220 an HCC code?
Yes. F12.220 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 F12.220
For F12.220 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 F12.220 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F12.220 is the ICD-10-CM diagnosis code for cannabis dependence with intoxication, uncomplicated. This code describes a patient who is dependent on cannabis (marijuana) and is currently intoxicated from using it, without any additional complications like withdrawal or perceptual disturbances. It indicates an ongoing substance use disorder with active intoxication at the time of assessment. F12.220 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, F12.220 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, F12.220 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.
Verify documentation clearly states both cannabis dependence AND current intoxication to justify this specific code; if only dependence is documented without active intoxication, use F12.20 instead. Because F12.220 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 F12.220 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify documentation clearly states both cannabis dependence AND current intoxication to justify this specific code; if only dependence is documented without active intoxication, use F12.20 instead
- •Ensure the intoxication is documented as 'uncomplicated' - if there are complications such as anxiety, paranoia, or other mental health effects, use a different F12.22x code variant
Clinical Significance
Cannabis dependence with uncomplicated intoxication captures a patient who meets criteria for cannabis dependence and is currently intoxicated at the time of the clinical encounter without additional complications. This combination indicates active substance use despite a documented dependence disorder, which is relevant for treatment planning and reflects ongoing disease burden. The dual documentation of dependence and active intoxication provides important clinical context.
Documentation Requirements
- ✓Documentation of cannabis dependence (tolerance, withdrawal history, compulsive use)
- ✓Evidence of current intoxication at the encounter
- ✓Description of intoxication symptoms (euphoria, impaired coordination, slowed reactions)
- ✓Confirmation that intoxication is uncomplicated — no delirium or perceptual disturbances
- ✓Assessment of safety and need for monitoring
Commonly Confused Codes
- •F12.20 — Cannabis dependence, uncomplicated; use when no intoxication is present
- •F12.221 — Cannabis dependence with intoxication delirium; use when delirium accompanies intoxication
- •F12.222 — Cannabis dependence with intoxication with perceptual disturbance; use when perceptual changes occur
- •F12.120 — Cannabis abuse with intoxication, uncomplicated; use when only abuse (not dependence) is documented