What is ICD-10 code F13.96?

F13.96 is the ICD-10-CM diagnosis code for Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced persisting amnestic disorder. A person has developed persistent memory loss and cognitive impairment from long-term sedative, hypnotic, or anti-anxiety medication use. F13.96 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. F13.96 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. F13.96 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. F13.96 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

Which HCC does F13.96 map to under V28?

F13.96 maps to CMS-HCC V28 135 (Drug Use with Psychotic Complications). The category number and label come from the CMS-HCC V28 model file for payment year 2026.

What does F13.96 pay in RAF?

F13.96 carries a community, non-dual, aged (CNA) RAF weight of 0.424 under CMS-HCC V28 for payment year 2026. The weight comes from the CMS V28 relative-factor file, not a hand-typed table.

What is the V28 vs V24 difference for F13.96?

CMS phased in the V28 risk adjustment model over payment years 2024 (33%), 2025 (67%), and 2026 (100%), replacing V24. V28 consolidates HCC categories, removes some lower-acuity conditions, and recalibrates RAF weights across the entire model. For F13.96, V28 maps to Drug Use with Psychotic Complications at RAF 0.424 while V24 mapped to Substance Use with Psychotic Complications at RAF 0.329. Both models can still appear in legacy data and in payer-specific lookback periods.

What documentation supports F13.96?

This represents a chronic condition; document the duration of substance use and cognitive testing results if available Distinguish from acute intoxication-related memory impairment by noting the persistent nature of the amnestic disorder Because F13.96 maps to a payment HCC, the documentation must also satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's risk adjustment score. See the MEAT criteria checklist at /meat-criteria for what Monitor, Evaluate, Assess, or Treat looks like in a note. MEAT is generic documentation evidence, not a payer-specific rule.

2026 ICD-10-CM F13.96: Sedative, hypnotic

F13.96 maps to CMS-HCC V28 135 (RAF 0.424). Documentation must support MEAT. MEAT criteria · RAF calculator · HCC Buddy coding tools

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Code lookupF13.96Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Mental, Behavioral and Neurodevelopmental disorders (F01-F99) / Mental and behavioral disorders due to psychoactive substance use (F10-F19)

F13.96

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced persisting amnestic disorder

A person has developed persistent memory loss and cognitive impairment from long-term sedative, hypnotic, or anti-anxiety medication use.

Buddy Insight

Persisting amnestic disorder from unspecified sedative use indicates permanent memory impairment caused by chronic sedative exposure.

CMS-HCC V28

Mapped

HCC 135

Drug Use with Psychotic Compl...

RAF 0.424

CMS-HCC V24

Mapped

HCC 54

Substance Use with Psychotic ...

RAF 0.329

ACA/HHS

Mapped

HCC 81

HHS-HCC 81

Varies by metal level

ESRD/PACE

Mapped

HCC 54

Substance Use with Psychotic ...

RAF 0.111

RXHCC

N/A

—

Not risk-adjusted for this model/period.

Not mapped

Code Book Path

Official

F13Sedative, hypnotic, or anxiolytic related disorders

F13.9Sedative, hypnotic or anxiolytic-related use, unspecified

F13.96Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced persisting amnestic disorder

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for F13.96 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for F13.96 in this effective period.

Related Child Codes

Official

F13.90Sedative, hypnotic, or anxiolytic use, unspecified, uncomplicated

F13.91Sedative, hypnotic or anxiolytic use, unspecified, in remission

F13.92Sedative, hypnotic or anxiolytic use, unspecified with intoxication

F13.93Sedative, hypnotic or anxiolytic use, unspecified with withdrawal

F13.94Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced mood disorder

Includes

Official

ICD-10-CM does not list Includes notes for F13.96 in this effective period.

Excludes 1

Official

sedative, hypnotic or anxiolytic-related abuse (F13.1-)
sedative, hypnotic or anxiolytic-related dependence (F13.2-)

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for F13.96 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for F13.96 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for F13.96 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Documentation of sedative, hypnotic, or anxiolytic use

Neuropsychological testing or cognitive assessment showing memory impairment

Evidence the amnestic disorder persists beyond acute substance effects

Type of memory impaired (anterograde, retrograde, short-term, long-term)

MEAT Support

HCC Buddy guidance

Documentation of sedative, hypnotic, or anxiolytic use

Neuropsychological testing or cognitive assessment showing memory impairment

Evidence the amnestic disorder persists beyond acute substance effects

Type of memory impaired (anterograde, retrograde, short-term, long-term)

Audit Caution

HCC Buddy guidance

Coding transient intoxication-related memory issues as persisting amnestic disorder

Confusing amnestic disorder (memory only) with dementia (multiple cognitive domains)

Using a non-substance amnesia code when substance etiology is documented

Missing this diagnosis in former substance users with ongoing memory deficits

Common Mistakes

HCC Buddy guidance

F13.97 — Unspecified use with persisting dementia; broader cognitive decline, not isolated memory

F13.26 — DEPENDENCE with persisting amnestic disorder; when dependence is confirmed

R41.3 — Other amnesia; does not capture substance-induced etiology

F04 — Amnestic disorder due to physiological condition; different etiology

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 F13.96 an HCC code?

Yes. F13.96 (Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced persisting amnestic disorder) maps to Drug Use with Psychotic Complications under the CMS-HCC V28 risk adjustment model (and Substance Use with Psychotic Complications under V24), with a community non-dual aged RAF of 0.424. It is billable for payment year 2026.

Coder answer: F13.96 is billable and maps to V28 HCC 135, Drug Use with Psychotic Complications. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code: F13.96
Description: Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced persisting amnestic disorder
HCC (V28): HCC 135 — Drug Use with Psychotic Complications
RAF: 0.424
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 135, Drug Use with Psychotic Complications

0.424

V24HCC 54, Substance Use with Psychotic Complications

0.329

ESRDHCC 54, Substance Use with Psychotic Complications

0.111

Each model's RAF is its CMS base weight for that model's standard population, so 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 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.

Work F13.96 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for F13.96

For F13.96 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 F13.96 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

F13.96 is the ICD-10-CM diagnosis code for sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced persisting amnestic disorder. A person has developed persistent memory loss and cognitive impairment from long-term sedative, hypnotic, or anti-anxiety medication use. F13.96 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, F13.96 maps to Drug Use with Psychotic Complications (HCC 135) with a community, non-dual, aged base RAF weight of 0.424. Under the older CMS-HCC V24 model, F13.96 maps to Substance Use with Psychotic Complications (HCC 54) with a community, non-dual, aged base RAF weight of 0.329. 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.

This represents a chronic condition; document the duration of substance use and cognitive testing results if available. Because F13.96 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 F13.96 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•This represents a chronic condition; document the duration of substance use and cognitive testing results if available
•Distinguish from acute intoxication-related memory impairment by noting the persistent nature of the amnestic disorder

Clinical Significance

Persisting amnestic disorder from unspecified sedative use indicates permanent memory impairment caused by chronic sedative exposure. The 'persisting' qualifier is critical — it means the memory loss continues even after substance use stops, reflecting actual brain damage. This is a serious cognitive complication that significantly impacts functional independence and quality of life.

Documentation Requirements

✓Documentation of sedative, hypnotic, or anxiolytic use
✓Neuropsychological testing or cognitive assessment showing memory impairment
✓Evidence the amnestic disorder persists beyond acute substance effects
✓Type of memory impaired (anterograde, retrograde, short-term, long-term)
✓Temporal relationship between substance use and memory impairment onset
✓Functional assessment documenting daily living impact

Commonly Confused Codes

•F13.97: Unspecified use with persisting dementia; broader cognitive decline, not isolated memory
•F13.26: DEPENDENCE with persisting amnestic disorder; when dependence is confirmed
•R41.3: Other amnesia; does not capture substance-induced etiology
•F04: Amnestic disorder due to physiological condition; different etiology
•F13.99: Unspecified induced disorder; less specific, does not capture the amnestic nature