F14.21
BillableCocaine dependence, in remission
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F14.21 an HCC code?
Yes. F14.21 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 F14.21
For F14.21 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 F14.21 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F14.21 is the ICD-10-CM diagnosis code for cocaine dependence, in remission. A person who was dependent on cocaine but is no longer actively using it and has achieved a period of recovery or abstinence. F14.21 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, F14.21 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, F14.21 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.
This code indicates dependence (not abuse) and requires documentation of remission status. Because F14.21 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 F14.21 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This code indicates dependence (not abuse) and requires documentation of remission status
- •Remission means the person is not currently meeting criteria for cocaine dependence despite past dependence
Clinical Significance
Cocaine dependence, in remission indicates a patient with a history of cocaine dependence who is no longer meeting active criteria for the disorder. This code is important for risk adjustment because even in remission, patients with cocaine dependence history require ongoing monitoring, relapse prevention, and screening for long-term health consequences including cardiovascular disease, cognitive impairment, and psychiatric comorbidities. The remission status does not eliminate the ongoing care needs and relapse risk.
Documentation Requirements
- ✓Provider must document a history of cocaine dependence (not just abuse)
- ✓Clear statement that the patient is currently in remission
- ✓Specification of remission type if possible (early remission vs. sustained remission per DSM-5)
- ✓Documentation of ongoing recovery activities or treatment (if applicable)
- ✓Assessment of relapse risk factors
- ✓Screening for long-term health consequences of prior cocaine use