What is ICD-10 code F13.130?

F13.130 is the ICD-10-CM diagnosis code for Sedative, hypnotic or anxiolytic abuse with withdrawal, uncomplicated. A person misuses sedatives, sleeping pills, or anti-anxiety medications and is experiencing withdrawal symptoms (such as anxiety, tremors, or insomnia) without severe complications. F13.130 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. F13.130 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. F13.130 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. F13.130 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

Which HCC does F13.130 map to under V28?

F13.130 maps to CMS-HCC V28 HCC 137 (Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications). The category numbers, labels, and conditions come from the CMS-HCC V28 model file for payment year 2026.

2026 ICD-10-CM F13.130: Sedative, hypnotic

F13.130 maps to CMS-HCC V28 137. A source-labeled RAF reference is available. Documentation must support MEAT. MEAT criteria · RAF Calculator · HCC coding software

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Code lookupF13.130Effective 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)

F13.130

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

Sedative, hypnotic or anxiolytic abuse with withdrawal, uncomplicated

A person misuses sedatives, sleeping pills, or anti-anxiety medications and is experiencing withdrawal symptoms (such as anxiety, tremors, or insomnia) without severe complications.

Buddy Insight

Sedative, hypnotic, or anxiolytic abuse with uncomplicated withdrawal captures a patient experiencing withdrawal symptoms after reducing or stopping sedative medications in the context of abuse.

CMS-HCC V28

Mapped

HCC 137

Drug Use Disorder, Moderate/S...

Code-level coefficient reference

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

Mapped

HCC 082

HHS-HCC 082 adult, RAF varies...

Code-level coefficient reference

ESRD/PACE

Mapped

HCC 55

Substance Use Disorder/Modera...

Code-level coefficient reference

RXHCC

N/A

—

Not risk-adjusted for this model/period.

Not mapped

Code Book Path

Official

F13.1Sedative, hypnotic or anxiolytic-related abuse

F13.13Sedative, hypnotic or anxiolytic abuse with withdrawal

F13.130Sedative, hypnotic or anxiolytic abuse with withdrawal, uncomplicated

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for F13.130 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for F13.130 in this effective period.

Related Child Codes

Official

F13.131Sedative, hypnotic or anxiolytic abuse with withdrawal delirium

F13.132Sedative, hypnotic or anxiolytic abuse with withdrawal with perceptual disturbance

F13.139Sedative, hypnotic or anxiolytic abuse with withdrawal, unspecified

Includes

Official

ICD-10-CM does not list Includes notes for F13.130 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for F13.130 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for F13.130 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for F13.130 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for F13.130 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Documentation of sedative/hypnotic/anxiolytic abuse

Specific withdrawal symptoms (anxiety, tremors, insomnia, nausea, tachycardia, sweating, irritability)

Temporal relationship between cessation/reduction and symptom onset

Confirmation of uncomplicated status — no seizures, delirium, or perceptual disturbances

MEAT Support

HCC Buddy guidance

Documentation of sedative/hypnotic/anxiolytic abuse

Specific withdrawal symptoms (anxiety, tremors, insomnia, nausea, tachycardia, sweating, irritability)

Temporal relationship between cessation/reduction and symptom onset

Confirmation of uncomplicated status — no seizures, delirium, or perceptual disturbances

Audit Caution

HCC Buddy guidance

Underestimating the severity potential of sedative withdrawal — even uncomplicated cases can progress rapidly to seizures or delirium

Using uncomplicated withdrawal codes when delirium or perceptual disturbances are present

Not monitoring for progression to complicated withdrawal

Coding dependence-level withdrawal when only abuse criteria are documented

Common Mistakes

HCC Buddy guidance

F13.131 — Sedative abuse with withdrawal delirium; use when delirium is present during withdrawal

F13.132 — Sedative abuse with withdrawal with perceptual disturbance; use when hallucinations occur during withdrawal

F13.139 — Sedative abuse with withdrawal, unspecified; use when withdrawal details are unclear

F13.230 — Sedative dependence with withdrawal, uncomplicated; use when dependence is documented

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 F13.130 an HCC code?

Yes. F13.130 (Sedative, hypnotic or anxiolytic abuse with withdrawal, uncomplicated) maps to HCC 137, Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.424. 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: F13.130 is billable and maps to V28 HCC 137, Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code: F13.130
Description: Sedative, hypnotic or anxiolytic abuse with withdrawal, uncomplicated
HCC (V28): HCC 137 — Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications
RAF reference coefficient: 0.424
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 137, Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications

0.424

ESRDHCC 55, Substance Use Disorder/Moderate/Severe/Substance Use with Complications

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 F13.130 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT Criteria for F13.130

For F13.130 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 F13.130 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

F13.130 is the ICD-10-CM diagnosis code for sedative, hypnotic or anxiolytic abuse with withdrawal, uncomplicated. A person misuses sedatives, sleeping pills, or anti-anxiety medications and is experiencing withdrawal symptoms (such as anxiety, tremors, or insomnia) without severe complications. F13.130 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, F13.130 maps to Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications (HCC 137) with a source-labeled community, non-dual, aged reference coefficient of 0.424. No V24 mapping is shown for F13.130; use the applicable model and payment year when reviewing the V28 mapping. 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. 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.

Withdrawal indicates the body is reacting to reduced or stopped use of these substances. Because F13.130 maps to an HCC category, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) before the diagnosis is used for risk adjustment. 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 F13.130 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Withdrawal indicates the body is reacting to reduced or stopped use of these substances
•Uncomplicated means no delirium or seizures are present; monitor for progression

Clinical Significance

Sedative, hypnotic, or anxiolytic abuse with uncomplicated withdrawal captures a patient experiencing withdrawal symptoms after reducing or stopping sedative medications in the context of abuse. Sedative withdrawal is medically significant because — unlike cannabis or opioid withdrawal — it can be life-threatening, with risks including seizures and delirium tremens. Even uncomplicated withdrawal requires careful monitoring for potential progression to more severe withdrawal states.

Documentation Requirements

✓Documentation of sedative/hypnotic/anxiolytic abuse
✓Specific withdrawal symptoms (anxiety, tremors, insomnia, nausea, tachycardia, sweating, irritability)
✓Temporal relationship between cessation/reduction and symptom onset
✓Confirmation of uncomplicated status — no seizures, delirium, or perceptual disturbances
✓Vital signs monitoring documentation
✓Assessment using a standardized withdrawal scale if available

Commonly Confused Codes

•F13.131: Sedative abuse with withdrawal delirium; use when delirium is present during withdrawal
•F13.132: Sedative abuse with withdrawal with perceptual disturbance; use when hallucinations occur during withdrawal
•F13.139: Sedative abuse with withdrawal, unspecified; use when withdrawal details are unclear
•F13.230: Sedative dependence with withdrawal, uncomplicated; use when dependence is documented