F13.220
BillableSedative, hypnotic or anxiolytic dependence with intoxication, uncomplicated
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F13.220 an HCC code?
Yes. F13.220 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 F13.220
For F13.220 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 F13.220 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F13.220 is the ICD-10-CM diagnosis code for sedative, hypnotic or anxiolytic dependence with intoxication, uncomplicated. A person dependent on sedative, hypnotic, or anti-anxiety medications is currently intoxicated from these drugs without severe complications like delirium. F13.220 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, F13.220 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, F13.220 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.
Document the level of intoxication and any behavioral or physical manifestations observed. Because F13.220 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 F13.220 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document the level of intoxication and any behavioral or physical manifestations observed
- •Distinguish from F13.221 which includes delirium as a complication
Clinical Significance
Sedative dependence with uncomplicated intoxication represents an acute clinical scenario where a dependent patient is currently under the influence of the substance without severe complications. This is clinically important as it confirms ongoing active use in a dependent patient, informing treatment urgency. Benzodiazepine intoxication can cause respiratory depression and requires monitoring.
Documentation Requirements
- ✓Provider documentation of sedative, hypnotic, or anxiolytic dependence
- ✓Description of current intoxication state and clinical findings
- ✓Vital signs and level of consciousness during intoxication
- ✓Confirmation that delirium or perceptual disturbances are NOT present (uncomplicated)
- ✓Specific substance involved and estimated quantity/route if known
- ✓Assessment of respiratory and cardiovascular status
Commonly Confused Codes
- •F13.221 — Sedative dependence with intoxication delirium; more severe with confusion and disorientation
- •F13.229 — Sedative dependence with intoxication unspecified; use when complication level cannot be determined
- •F13.120 — Sedative ABUSE with intoxication uncomplicated; less severe use pattern
- •F13.920 — Unspecified sedative use with intoxication; use when abuse vs dependence is unclear
- •F13.20 — Uncomplicated dependence; does not capture current intoxication state