F13.11 maps to CMS-HCC V28 138. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · free HCC coding tools

ICD-10-CM Code View

HCC Buddy Code Card

Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.

Code lookupF13.11

Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Mental, Behavioral and Neurodevelopmental disorders (F01-F99) / Mental and behavioral disorders due to psychoactive substance use (F10-F19)

F13.11

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Sedative, hypnotic or anxiolytic abuse, in remission

A person previously misused sedatives, sleeping pills, or anti-anxiety medications but is now in recovery and no longer actively abusing these substances.

Buddy Insight

Sedative, hypnotic, or anxiolytic abuse in remission documents a patient who previously misused these medications but is now in recovery.

Overview Risk Models Code Book Documentation Audit Notes Edition comparison

CMS-HCC V28

Mapped

HCC 138

Drug Use Disorder, Mild, Unco...

Coefficient HCC 138: 0.423 (Community Non-Dual Aged (CNA))

CMS-HCC V24

Historical

Not used for standard CY2026 Medicare Advantage payment. Select a historical period to review V24.

Not used for CY2026 payment

ACA/HHS

N/A

—

Not risk-adjusted for this model/period.

Not mapped

ESRD/PACE

Mapped

HCC 56

Substance Use Disorder/Mild/E...

Code-level coefficient reference

RXHCC

N/A

—

Not risk-adjusted for this model/period.

Not mapped

Code Book Path

Official

F13Sedative, hypnotic, or anxiolytic related disorders F13.1Sedative, hypnotic or anxiolytic-related abuse F13.11Sedative, hypnotic or anxiolytic abuse, in remission

Inclusion Terms

Official

Sedative, hypnotic or anxiolytic use disorder, mild, in early remission
Sedative, hypnotic or anxiolytic use disorder, mild, in sustained remission

Excludes 2

Official

symptoms, signs and abnormal clinical laboratory findings, not elsewhere classified (R00-R99)Inherited from F01-F99

Related Codes

Official

F13.10Sedative, hypnotic or anxiolytic abuse, uncomplicated F13.12Sedative, hypnotic or anxiolytic abuse with intoxication F13.13Sedative, hypnotic or anxiolytic abuse with withdrawal F13.14Sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-induced mood disorder F13.15Sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-induced psychotic disorder

Includes

Official

disorders of psychological developmentInherited from F01-F99

Excludes 1

Official

sedative, hypnotic or anxiolytic-related dependence (F13.2-)Inherited from F13.1
sedative, hypnotic, or anxiolytic use, unspecified (F13.9-)Inherited from F13.1

Code First

Official

No Code First sequencing instructions are included in this display for F13.11. Check the code and parent instructions in the Code Book.

Use Additional

Official

No Use Additional Code instructions are included in this display for F13.11. Check the code and parent instructions in the Code Book.

Code Also

Official

No Code Also instructions are included in this display for F13.11. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance

History of sedative, hypnotic, or anxiolytic abuse meeting clinical criteria

Documentation of current abstinence from the abused substance(s)

Duration of remission (early or sustained) if available

Ongoing monitoring plan and relapse prevention strategies

MEAT Support

HCC Buddy guidance

History of sedative, hypnotic, or anxiolytic abuse meeting clinical criteria

Documentation of current abstinence from the abused substance(s)

Duration of remission (early or sustained) if available

Ongoing monitoring plan and relapse prevention strategies

Audit Caution

HCC Buddy guidance

Using active abuse codes when the patient is in documented remission

Dropping the diagnosis entirely during remission — the code should still be reported for ongoing risk adjustment

Coding abuse in remission when the historical disorder was actually at the dependence level

Not documenting the length of remission, which provides important clinical context

Common Mistakes

HCC Buddy guidance

F13.10 — Sedative, hypnotic or anxiolytic abuse, uncomplicated; use when abuse is active (not in remission)

F13.21 — Sedative, hypnotic or anxiolytic dependence, in remission; use when the historical disorder was dependence-level

Z87.890 — Personal history of other mental and behavioral disorders; less specific for substance use history

F13.90 — Sedative, hypnotic or anxiolytic use, unspecified, uncomplicated; use when severity is unspecified

Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →

Is F13.11 an HCC code?

Yes. F13.11 (Sedative, hypnotic or anxiolytic abuse, in remission) maps to HCC 138, Drug Use Disorder, Mild, Uncomplicated, Except Cannabis under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.423. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.

Coder answer: F13.11 is billable and maps to V28 HCC 138, Drug Use Disorder, Mild, Uncomplicated, Except Cannabis. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code: F13.11
Description: Sedative, hypnotic or anxiolytic abuse, in remission
HCC (V28): HCC 138 — Drug Use Disorder, Mild, Uncomplicated, Except Cannabis
RAF reference coefficient: 0.423
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 138, Drug Use Disorder, Mild, Uncomplicated, Except Cannabis

0.423

ESRDHCC 56, Substance Use Disorder/Mild/Except Alcohol and Cannabis

Not separately weighted

These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. Weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.

Work F13.11 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for F13.11

For F13.11, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.

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

Coder workflow notes

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What This Code Means

F13.11 is the ICD-10-CM diagnosis code for sedative, hypnotic or anxiolytic abuse, in remission. A person previously misused sedatives, sleeping pills, or anti-anxiety medications but is now in recovery and no longer actively abusing these substances. F13.11 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, F13.11 maps to Drug Use Disorder, Mild, Uncomplicated, Except Cannabis (HCC 138) with a source-labeled community, non-dual, aged reference coefficient of 0.423. For CY2026 non-PACE Medicare Advantage, CMS uses 100% of the 2024 CMS-HCC model (V28). PACE uses a separate model blend. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.

In remission indicates the patient has achieved sustained abstinence or controlled use. For F13.11, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule. 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, source-labeled coefficient references, and MEAT documentation criteria for F13.11 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•In remission indicates the patient has achieved sustained abstinence or controlled use
•Document the length of remission (early or sustained) if available for more specific coding

Clinical Significance

Sedative, hypnotic, or anxiolytic abuse in remission documents a patient who previously misused these medications but is now in recovery. This is clinically significant because it recognizes the chronic relapsing nature of substance abuse and the need for ongoing monitoring. Patients with a history of sedative abuse remain at elevated risk for relapse, particularly when prescribed benzodiazepines or other sedating medications in the future.

Documentation Requirements

✓History of sedative, hypnotic, or anxiolytic abuse meeting clinical criteria
✓Documentation of current abstinence from the abused substance(s)
✓Duration of remission (early or sustained) if available
✓Ongoing monitoring plan and relapse prevention strategies
✓Provider statement confirming remission status

Commonly Confused Codes

•F13.10: Sedative, hypnotic or anxiolytic abuse, uncomplicated; use when abuse is active (not in remission)
•F13.21: Sedative, hypnotic or anxiolytic dependence, in remission; use when the historical disorder was dependence-level
•Z87.890: Personal history of other mental and behavioral disorders; less specific for substance use history
•F13.90: Sedative, hypnotic or anxiolytic use, unspecified, uncomplicated; use when severity is unspecified