F13.21 ICD-10-CM Code: Sedative, hypnotic or anxiolytic dependence, in remission
F13.21 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 · HCC Buddy coding tools
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FY 2026 Apr update / Mental, Behavioral and Neurodevelopmental disorders (F01-F99) / Mental and behavioral disorders due to psychoactive substance use (F10-F19)
F13.21
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceSedative, hypnotic or anxiolytic dependence, in remission
A person who previously had dependence on sedative, hypnotic, or anti-anxiety medications is now in remission, meaning they are no longer actively using or dependent on these substances.
Buddy Insight
Sedative dependence in remission indicates a patient who previously met dependence criteria but has achieved a period of recovery.
CMS-HCC V28
MappedHCC 137
Coefficient HCC 137: 0.424 (Community Non-Dual Aged (CNA))
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
MappedHCC 082
Code-level coefficient reference
ESRD/PACE
MappedHCC 55
Code-level coefficient reference
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
Official- Sedative, hypnotic or anxiolytic use disorder, moderate, in early remission
- Sedative, hypnotic or anxiolytic use disorder, moderate, in sustained remission
- Sedative, hypnotic or anxiolytic use disorder, severe, in early remission
- Sedative, hypnotic or anxiolytic use disorder, severe, in sustained remission
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
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
OfficialNo Code First sequencing instructions are included in this display for F13.21. Check the code and parent instructions in the Code Book.
Use Additional
OfficialNo Use Additional Code instructions are included in this display for F13.21. Check the code and parent instructions in the Code Book.
Code Also
OfficialNo Code Also instructions are included in this display for F13.21. Check the code and parent instructions in the Code Book.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
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 F13.21 an HCC code?
Yes. F13.21 (Sedative, hypnotic or anxiolytic dependence, in remission) 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: F13.21 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
- F13.21
- Description
- Sedative, hypnotic or anxiolytic dependence, in remission
- 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
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 F13.21 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for F13.21
For F13.21, 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
F13.21 is the ICD-10-CM diagnosis code for sedative, hypnotic or anxiolytic dependence, in remission. A person who previously had dependence on sedative, hypnotic, or anti-anxiety medications is now in remission, meaning they are no longer actively using or dependent on these substances. F13.21 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, F13.21 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. 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, in remission. Historical dependence with current sustained remission, the provider narrative must cite the remission status explicitly. For F13.21, 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 F13.21 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, in remission. Historical dependence with current sustained remission, the provider narrative must cite the remission status explicitly.
- •Do not drop this code at remission, it still risk-adjusts. Also, distinguish from F13.20 (active dependence) based on the current clinical note, not a one-time historical mention.
- •Remission status is documentation-relevant and helps audit defense even though the HCC continues to map.
Clinical Significance
Sedative dependence in remission indicates a patient who previously met dependence criteria but has achieved a period of recovery. This is an important chronic condition to document annually, as it reflects ongoing relapse risk and the need for monitoring. Even in remission, the dependence history remains clinically relevant for medication management and risk adjustment, as these patients require continued oversight.
Documentation Requirements
- ✓Provider documentation of prior sedative, hypnotic, or anxiolytic dependence
- ✓Explicit statement that the patient is currently in remission
- ✓Duration of remission if available (early vs sustained)
- ✓Current substance use status (abstinent, controlled, etc.)
- ✓Ongoing treatment or monitoring plan for relapse prevention
- ✓Assessment confirming no current active dependence symptoms
Commonly Confused Codes
- •F13.20: Sedative dependence uncomplicated; patient still has active dependence, not in remission
- •F13.11: Sedative ABUSE in remission; less severe use pattern history
- •Z87.898: Personal history of other specified conditions; does not capture the specific substance history
- •F13.90: Unspecified sedative use; does not capture the dependence or remission status
- •Z86.59: Personal history of other mental and behavioral disorders; less specific than F13.21