F12.93
BillableCannabis use, unspecified with withdrawal
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F12.93 an HCC code?
Yes. F12.93 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 F12.93
For F12.93 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 F12.93 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F12.93 is the ICD-10-CM diagnosis code for cannabis use, unspecified with withdrawal. This code describes a patient who uses cannabis (marijuana) but the specific pattern of use is not documented, and they are experiencing withdrawal symptoms from stopping or reducing their cannabis use. Withdrawal can include symptoms like irritability, sleep problems, anxiety, and decreased appetite. F12.93 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, F12.93 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, F12.93 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.
Use this code only when the documentation indicates cannabis withdrawal symptoms are present but does not specify if use is mild, moderate, or severe. Because F12.93 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 F12.93 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use this code only when the documentation indicates cannabis withdrawal symptoms are present but does not specify if use is mild, moderate, or severe
- •If the provider documents a specific severity level (mild, moderate, or severe) or specifies the type of cannabis use disorder, select a more specific F12 code instead of the 'unspecified' code
Clinical Significance
Cannabis use, unspecified with withdrawal documents withdrawal symptoms in a patient whose cannabis use severity is not specified. Cannabis withdrawal syndrome is clinically significant as it confirms physiological adaptation and may impact treatment decisions. Even with unspecified use severity, documenting withdrawal is important because it provides risk adjustment value in both V24 and V28 models and indicates the need for withdrawal management support.
Documentation Requirements
- ✓Documentation of cannabis use
- ✓Specific withdrawal symptoms (irritability, anxiety, insomnia, decreased appetite, restlessness, depressed mood)
- ✓Temporal relationship between cessation or reduction of cannabis use and symptom onset
- ✓Duration and severity of withdrawal symptoms
- ✓Treatment plan for withdrawal symptom management