F13.230
BillableSedative, hypnotic or anxiolytic dependence with withdrawal, uncomplicated
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F13.230 an HCC code?
Yes. F13.230 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 F13.230
For F13.230 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 F13.230 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F13.230 is the ICD-10-CM diagnosis code for sedative, hypnotic or anxiolytic dependence with withdrawal, uncomplicated. A person dependent on sedative, hypnotic, or anti-anxiety medications is experiencing withdrawal symptoms without severe complications like delirium or hallucinations. F13.230 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, F13.230 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, F13.230 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 specific withdrawal symptoms such as tremors, anxiety, insomnia, or sweating. Because F13.230 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 F13.230 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
Clinical Significance
Sedative dependence with uncomplicated withdrawal is a clinically significant and potentially dangerous condition. Sedative/hypnotic withdrawal, particularly from benzodiazepines and barbiturates, can progress to seizures and death if not properly managed. Even uncomplicated withdrawal requires medical monitoring. This code indicates active withdrawal without delirium or perceptual disturbances, but the condition still demands clinical vigilance.
Documentation Requirements
- ✓Documentation of sedative, hypnotic, or anxiolytic dependence
- ✓Description of withdrawal symptoms (tremor, anxiety, insomnia, diaphoresis, tachycardia, nausea)
- ✓CIWA-B or other withdrawal severity assessment scores if available
- ✓Confirmation that delirium and perceptual disturbances are NOT present
- ✓Timeline of last substance use and onset of withdrawal symptoms
- ✓Taper protocol or withdrawal management plan documentation