F13.930
BillableSedative, hypnotic or anxiolytic use, unspecified with withdrawal, uncomplicated
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F13.930 an HCC code?
Yes. F13.930 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 F13.930
For F13.930 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 F13.930 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F13.930 is the ICD-10-CM diagnosis code for sedative, hypnotic or anxiolytic use, unspecified with withdrawal, uncomplicated. This code describes a situation where a person has been using sedative, hypnotic, or anti-anxiety medications (like benzodiazepines) without a clear pattern of abuse or dependence, and is experiencing withdrawal symptoms that are not severe or complicated. Withdrawal occurs when someone stops taking these medications after regular use, causing symptoms like anxiety, tremors, or sleep problems. F13.930 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, F13.930 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, F13.930 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 only when withdrawal is documented as 'uncomplicated' - if there are seizures, delirium, or other severe symptoms, use a different withdrawal code (F13.931 for complicated withdrawal). Because F13.930 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 F13.930 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use this code only when withdrawal is documented as 'uncomplicated' - if there are seizures, delirium, or other severe symptoms, use a different withdrawal code (F13.931 for complicated withdrawal)
- •The 'unspecified' component means the documentation does not clearly indicate abuse, dependence, or in remission status - clarify with the provider if a more specific use disorder code (F13.1x, F13.2x) would be more appropriate
Clinical Significance
Unspecified sedative use with uncomplicated withdrawal indicates a patient is experiencing withdrawal symptoms but the provider has not documented whether the use pattern constitutes abuse or dependence. Sedative withdrawal is medically dangerous and can progress to seizures, regardless of the classified use pattern. This code captures the clinical urgency while flagging a documentation improvement opportunity.
Documentation Requirements
- ✓Documentation of withdrawal symptoms from sedative, hypnotic, or anxiolytic substance
- ✓Specific withdrawal symptoms present (tremor, anxiety, insomnia, tachycardia, diaphoresis)
- ✓Confirmation that delirium and perceptual disturbances are NOT present
- ✓Timeline of last substance use and withdrawal onset
- ✓Withdrawal management plan and monitoring protocol
- ✓Attempt to determine use pattern (abuse vs dependence) documented