What is ICD-10 code F13.20?

F13.20 is the ICD-10-CM diagnosis code for Sedative, hypnotic or anxiolytic dependence, uncomplicated. A person has developed a dependence on sedative, hypnotic, or anti-anxiety medications without any current complications or withdrawal symptoms. It belongs to the ICD-10-CM chapter for mental, behavioral and neurodevelopmental disorders (f01-f99). F13.20 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. F13.20 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. F13.20 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. F13.20 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 F13.20 map to under V28?

F13.20 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.

What documentation supports F13.20?

Sedative, hypnotic, or anxiolytic dependence, uncomplicated. The chart must document dependence, tolerance, withdrawal concerns on dose changes, or continued use despite harm. Do not use F13.20 for appropriate long-term benzodiazepine therapy in a non-dependent patient, the DSM dependence pattern is required. Chronic prescription alone is not sufficient. V28 HCC 137 (Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications) at RAF 0.424. Benzodiazepine dependence is clinically meaningful and documentation-sensitive; auditors scrutinize long-term Rx patients flagged as F13.20. For F13.20, 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. See the MEAT criteria checklist at /meat-criteria for what Monitor, Evaluate, Assess, or Treat looks like in a note. One mnemonic element does not establish that a diagnosis is reportable.

2026 ICD-10-CM F13.20: Sedative, hypnotic

F13.20 maps to CMS-HCC V28 137. 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

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Code lookupF13.20

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)

F13.20

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

Sedative, hypnotic or anxiolytic dependence, uncomplicated

A person has developed a dependence on sedative, hypnotic, or anti-anxiety medications without any current complications or withdrawal symptoms.

Buddy Insight

Uncomplicated sedative dependence represents a more severe substance use pattern than abuse, indicating physiological or psychological dependence on sedatives, hypnotics, or anxiolytics.

Overview Risk Models Code Book Documentation Audit Notes Edition comparison

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

F13Sedative, hypnotic, or anxiolytic related disorders F13.2Sedative, hypnotic or anxiolytic-related dependence F13.20Sedative, hypnotic or anxiolytic dependence, uncomplicated

Inclusion Terms

Official

No inclusion terms are included in this display for F13.20. Check the code and parent instructions in the Code Book.

Excludes 2

Official

symptoms, signs and abnormal clinical laboratory findings, not elsewhere classified (R00-R99)Inherited from F01-F99, F13.2
sedative, hypnotic, or anxiolytic poisoning (T42.-)Inherited from F01-F99, F13.2

Related Codes

Official

F13.21Sedative, hypnotic or anxiolytic dependence, in remission F13.22Sedative, hypnotic or anxiolytic dependence with intoxication F13.23Sedative, hypnotic or anxiolytic dependence with withdrawal F13.24Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced mood disorder F13.25Sedative, hypnotic or anxiolytic dependence 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 abuse (F13.1-)Inherited from F13.2
sedative, hypnotic, or anxiolytic use, unspecified (F13.9-)Inherited from F13.2

Code First

Official

No Code First sequencing instructions are included in this display for F13.20. Check the code and parent instructions in the Code Book.

Use Additional

Official

No Use Additional Code instructions are included in this display for F13.20. Check the code and parent instructions in the Code Book.

Code Also

Official

No Code Also instructions are included in this display for F13.20. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance

Provider documentation explicitly stating 'dependence' on sedative, hypnotic, or anxiolytic substances

Identification of the specific substance (benzodiazepine, barbiturate, zolpidem, etc.)

Evidence of dependence criteria: tolerance, withdrawal symptoms, compulsive use, inability to cut down

Confirmation that no current intoxication, withdrawal, or induced disorders are present (uncomplicated)

MEAT Support

HCC Buddy guidance

Provider documentation explicitly stating 'dependence' on sedative, hypnotic, or anxiolytic substances

Identification of the specific substance (benzodiazepine, barbiturate, zolpidem, etc.)

Evidence of dependence criteria: tolerance, withdrawal symptoms, compulsive use, inability to cut down

Confirmation that no current intoxication, withdrawal, or induced disorders are present (uncomplicated)

Audit Caution

HCC Buddy guidance

Coding abuse (F13.10) when the documentation clearly supports dependence criteria

Assigning 'uncomplicated' when the record documents intoxication, withdrawal, or induced disorders

Confusing prescribed therapeutic use with dependence — physiological dependence from prescribed use requires careful clinical distinction

Missing the opportunity to capture dependence and defaulting to unspecified use (F13.90)

Common Mistakes

HCC Buddy guidance

F13.10 — Sedative ABUSE uncomplicated; abuse is less severe than dependence and carries a lower HCC

F13.21 — Sedative dependence in remission; patient is no longer actively dependent

F13.220 — Sedative dependence with intoxication; patient is currently intoxicated

F13.230 — Sedative dependence with withdrawal; patient is currently in withdrawal

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 F13.20 an HCC code?

Yes. F13.20 (Sedative, hypnotic or anxiolytic dependence, 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: F13.20 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: F13.20
Description: Sedative, hypnotic or anxiolytic dependence, 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 F13.20 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for F13.20

For F13.20, 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

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What This Code Means

F13.20 is the ICD-10-CM diagnosis code for sedative, hypnotic or anxiolytic dependence, uncomplicated. A person has developed a dependence on sedative, hypnotic, or anti-anxiety medications without any current complications or withdrawal symptoms. F13.20 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, F13.20 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 F13.20; use the applicable model and payment year when reviewing the V28 mapping. 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.

Sedative, hypnotic, or anxiolytic dependence, uncomplicated. The chart must document dependence, tolerance, withdrawal concerns on dose changes, or continued use despite harm. For F13.20, 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 F13.20 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Sedative, hypnotic, or anxiolytic dependence, uncomplicated. The chart must document dependence, tolerance, withdrawal concerns on dose changes, or continued use despite harm.
•Do not use F13.20 for appropriate long-term benzodiazepine therapy in a non-dependent patient, the DSM dependence pattern is required. Chronic prescription alone is not sufficient.
•Benzodiazepine dependence is clinically meaningful and documentation-sensitive; auditors scrutinize long-term Rx patients flagged as F13.20.

Clinical Significance

Uncomplicated sedative dependence represents a more severe substance use pattern than abuse, indicating physiological or psychological dependence on sedatives, hypnotics, or anxiolytics. This is clinically significant because benzodiazepine and other sedative dependence carries serious risks including potentially life-threatening withdrawal. The dependence classification reflects a higher level of clinical complexity and treatment need than abuse.

Documentation Requirements

✓Provider documentation explicitly stating 'dependence' on sedative, hypnotic, or anxiolytic substances
✓Identification of the specific substance (benzodiazepine, barbiturate, zolpidem, etc.)
✓Evidence of dependence criteria: tolerance, withdrawal symptoms, compulsive use, inability to cut down
✓Confirmation that no current intoxication, withdrawal, or induced disorders are present (uncomplicated)
✓Current treatment status and plan for the dependence
✓Duration and pattern of substance use supporting dependence diagnosis

Commonly Confused Codes

•F13.10: Sedative ABUSE uncomplicated; abuse is less severe than dependence and carries a lower HCC
•F13.21: Sedative dependence in remission; patient is no longer actively dependent
•F13.220: Sedative dependence with intoxication; patient is currently intoxicated
•F13.230: Sedative dependence with withdrawal; patient is currently in withdrawal
•F13.90: Sedative use, unspecified; use when abuse vs dependence cannot be determined