F13.20
BillableSedative, hypnotic or anxiolytic dependence, uncomplicated
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F13.20 an HCC code?
Yes. F13.20 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 F13.20
For F13.20 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 F13.20 during that encounter — not just copy-forwarded from a problem list.
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/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, F13.20 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 when dependence is documented without intoxication, withdrawal, or other specified complications. Because F13.20 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 F13.20 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use this code when dependence is documented without intoxication, withdrawal, or other specified complications
- •Verify the substance is specifically a sedative, hypnotic, or anxiolytic drug rather than other depressants
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