F13.120
BillableSedative, hypnotic or anxiolytic abuse with intoxication, uncomplicated
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F13.120 an HCC code?
Yes. F13.120 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 F13.120
For F13.120 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 F13.120 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F13.120 is the ICD-10-CM diagnosis code for sedative, hypnotic or anxiolytic abuse with intoxication, uncomplicated. A person misuses sedatives, sleeping pills, or anti-anxiety medications and is currently intoxicated from these drugs, without severe complications like delirium. F13.120 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, F13.120 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, F13.120 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.
Intoxication indicates active drug effects present at time of assessment. Because F13.120 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 F13.120 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Intoxication indicates active drug effects present at time of assessment
- •Uncomplicated means no delirium or other severe mental status changes are occurring
Clinical Significance
Sedative, hypnotic, or anxiolytic abuse with uncomplicated intoxication identifies a patient currently under the influence of these substances in the context of documented abuse. Sedative intoxication can present with slurred speech, incoordination, unsteady gait, impaired attention, and memory difficulties. This diagnosis is important because sedative intoxication carries risks of respiratory depression, aspiration, and falls, particularly in combination with other central nervous system depressants.
Documentation Requirements
- ✓Documentation of sedative/hypnotic/anxiolytic abuse pattern
- ✓Evidence of current intoxication at the encounter
- ✓Description of intoxication symptoms (slurred speech, incoordination, sedation, cognitive impairment)
- ✓Confirmation that intoxication is uncomplicated — no delirium present
- ✓Identification of the specific substance if possible
- ✓Assessment of respiratory status and fall risk
Commonly Confused Codes
- •F13.10 — Sedative, hypnotic or anxiolytic abuse, uncomplicated; use when no intoxication is present
- •F13.121 — Sedative, hypnotic or anxiolytic abuse with intoxication delirium; use when delirium accompanies intoxication
- •F13.220 — Sedative, hypnotic or anxiolytic dependence with intoxication, uncomplicated; use when dependence is documented
- •T42.4X1A — Poisoning by benzodiazepines, accidental; use when overdose/poisoning is the clinical scenario