F14.11
BillableCocaine abuse, in remission
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F14.11 an HCC code?
Yes. F14.11 maps to Drug Use Disorder/Substance Use Disorder, Mild under the CMS-HCC V28 risk adjustment model (and Drug/Alcohol Abuse, Without 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 F14.11
For F14.11 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 F14.11 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F14.11 is the ICD-10-CM diagnosis code for cocaine abuse, in remission. A person previously abused cocaine but is no longer using it and has maintained recovery for a sustained period. F14.11 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, F14.11 maps to Drug Use Disorder/Substance Use Disorder, Mild (HCC 138) with a community, non-dual, aged base RAF weight of 0.476. Under the older CMS-HCC V24 model, F14.11 maps to Drug/Alcohol Abuse, Without Dependence (HCC 56) with a community, non-dual, aged base RAF weight of 0.000. 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.
The remission status indicates the patient is not currently using cocaine; document the length of remission if available. Because F14.11 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 F14.11 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •The remission status indicates the patient is not currently using cocaine; document the length of remission if available
- •This code can be used even if the patient is receiving treatment or monitoring for their past cocaine abuse
Clinical Significance
Cocaine abuse in remission indicates a patient who previously met cocaine abuse criteria but has achieved a period of recovery. This is an important chronic condition to recapture annually, as it reflects ongoing relapse risk and the need for monitoring and support services. The remission status confirms the patient is not currently using cocaine but maintains a clinically relevant substance use history.
Documentation Requirements
- ✓Provider documentation of prior cocaine abuse
- ✓Explicit statement that the patient is currently in remission
- ✓Duration of remission if available (early vs sustained)
- ✓Current substance use status (abstinent, in treatment, etc.)
- ✓Ongoing monitoring or treatment plan for relapse prevention
- ✓Screening for comorbid conditions common in cocaine users