F13.981
BillableSedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced sexual dysfunction
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F13.981 an HCC code?
Yes. F13.981 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 F13.981
For F13.981 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 F13.981 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F13.981 is the ICD-10-CM diagnosis code for sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced sexual dysfunction. This code describes sexual dysfunction that is caused by the use of sedative, hypnotic, or anti-anxiety medications, when the specific pattern of drug use is not clearly documented. Sexual dysfunction can include problems with desire, arousal, or performance related to these medications. F13.981 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, F13.981 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, F13.981 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.
Verify documentation clearly links the sexual dysfunction to sedative, hypnotic, or anxiolytic medication use; if the specific pattern of use (abuse, dependence, or use disorder) is documented, select the more specific F13.9x1 code instead. Because F13.981 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 F13.981 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify documentation clearly links the sexual dysfunction to sedative, hypnotic, or anxiolytic medication use; if the specific pattern of use (abuse, dependence, or use disorder) is documented, select the more specific F13.9x1 code instead
- •This code requires documentation of both the medication-induced sexual dysfunction AND the use of sedatives/hypnotics/anxiolytics; ensure both conditions are present in the medical record before coding
Clinical Significance
Sexual dysfunction induced by unspecified sedative use reflects a quality-of-life complication from sedative medication use. The unspecified use pattern indicates the provider documented the sexual dysfunction as substance-related without classifying the use severity. This is important for comprehensive documentation and may influence shared decision-making about continued sedative use.
Documentation Requirements
- ✓Documentation of sedative, hypnotic, or anxiolytic use
- ✓Specific type of sexual dysfunction (erectile dysfunction, decreased libido, anorgasmia)
- ✓Provider attribution linking sexual dysfunction to the substance use
- ✓Ruling out other causes of sexual dysfunction
- ✓Temporal relationship between substance use and sexual dysfunction onset
- ✓Impact assessment on quality of life