2027 ICD-10-CM Diagnosis Code F13.11Sedative, hypnotic or anxiolytic abuse, in remission

ICD-10-CM Codes›F01–F99›F10-F19›F13

ICD-10-CM F13.11
CMSSource: CMS FY 2027 ICD-10-CM dataset · Effective Oct 1, 2026 – Sep 30, 2027

F13.11 is a billable ICD-10-CM diagnosis code for sedative, hypnotic or anxiolytic abuse, in remission. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 894 through 897. Coders also document this condition as harmful pattern of use of anxiolytic. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Mental and substance use disorders in remission.

For Medicare Advantage risk adjustment, F13.11 maps to CMS-HCC Category 138 (Drug Use Disorder, Mild, Uncomplicated, Except Cannabis) under the V28 model, adding a risk factor of about 0.423 for a community, non-dual, aged beneficiary in payment year 2027.

Code Identity

ICD-10-CM Code
F13.11
Billable Status
Yes — Valid for Submission
Code Describes
Sedative, hypnotic or anxiolytic abuse, in remission
Short Description
Sedative, hypnotic or anxiolytic abuse, in remission
Same as the full description in the CMS dataset.
Parent Code
F13.1
Sedative, hypnotic or anxiolytic-related abuse

Code Classification

ChapterF01–F99Mental and behavioural disorders
SectionF10-F19Mental and behavioral disorders due to psychoactive substance use
CategoryF13Sedative, hypnotic, or anxiolytic related disorders
This CodeF13.11Sedative, hypnotic or anxiolytic abuse, in remission

Medicare Risk Adjustment (HCC)Billing

F13.11 maps to a payment category in the CMS-HCC model used to risk-adjust Medicare Advantage payments. Weights are the published community factors for payment year 2027.

CMS-HCC V28 Category (Payment Model)
HCC 138— Drug Use Disorder, Mild, Uncomplicated, Except Cannabis
Payment HCC · PY 2027 one of 14 ICD-10-CM codes in this category
Risk Adjustment Factor (RAF) Weight
+0.423
community, non-dual, aged · ranges 0.264–0.502 across segments
Hierarchy
Superseded by HCC 135, HCC 136, and HCC 137
a more severe related category takes the payment when both are reported
Prior Model (CMS-HCC V24)
HCC 56
V24 retired V28 pays 100% of MA risk scores since PY 2026
Other CMS Models
ESRD (V24): HCC 56
ESRD V24 weights: 0.111 dialysis, 0.169–0.416 functioning graft
Part D (RxHCC)
Not mapped
F13.11 does not risk-adjust in the RxHCC prescription drug model

Source: CMS Payment Year 2027 risk adjustment mappings and model software. Weights are relative factors, not dollar amounts; a beneficiary's total RAF also includes demographics and interactions. Browse all CMS-HCC categories.

Approximate SynonymsGuidance

Alternate terms and clinical phrases that map to this code.

  • Harmful pattern of use of anxiolytic
  • Harmful pattern of use of hypnotic
  • History of anxiolytic abuse
  • History of sedative hypnotic abuse
  • Nondependent harmful pattern of use of anxiolytic
  • Nondependent harmful pattern of use of anxiolytic in remission
  • Nondependent harmful pattern of use of hypnotic
  • Nondependent harmful pattern of use of hypnotic in remission

Instructional NotesGuidance

Instructions from the official ICD-10-CM Tabular List that apply to F13.11: its own notes plus those printed at F13.1 and Chapter 5. A note printed at a category, block or chapter applies to every code under it.

Includes

Further defines, or gives examples of, the content of the category.

From Chapter 5 (F01-F99) Mental and behavioural disorders applies to 872 codes
  • disorders of psychological development

Applicable To

Conditions this code is used for: synonyms of the title or, for "other specified" codes, the conditions assigned to it. The list is not exhaustive.

  • Sedative, hypnotic or anxiolytic use disorder, mild, in early remission
  • Sedative, hypnotic or anxiolytic use disorder, mild, in sustained remission

Excludes1

Not coded here: the excluded code is never reported together with this one, unless the two conditions are unrelated.

From F13.1 Sedative, hypnotic or anxiolytic-related abuse applies to 18 codes
  • sedative, hypnotic or anxiolytic-related dependence (F13.2-)
  • sedative, hypnotic, or anxiolytic use, unspecified (F13.9-)

Excludes2

Not included here: the excluded condition is not part of this code, but a patient may have both, so both codes may be reported.

From Chapter 5 (F01-F99) Mental and behavioural disorders applies to 872 codes
  • symptoms, signs and abnormal clinical laboratory findings, not elsewhere classified (R00-R99)

Source: CMS ICD-10-CM Tabular List. How to read instructional notes.

Referenced in Other NotesGuidance

Instructional notes printed at other codes that name F13.11, its category, or a range that includes it.

Excludes1 2

These codes carry an Excludes1 note naming F13.11: they are not reported together with it, unless the two conditions are unrelated.

  • F13.2 Sedative, hypnotic or anxiolytic-related dependence
    sedative, hypnotic or anxiolytic-related abuse (F13.1-) names F13.1-, which includes this code
  • F13.9 Sedative, hypnotic or anxiolytic-related use, unspecified
    sedative, hypnotic or anxiolytic-related abuse (F13.1-) names F13.1-, which includes this code

Excludes2 1

These codes carry an Excludes2 note naming F13.11: its condition is not part of those codes, and both may be reported when the patient has both.

  • F44.0 Dissociative amnesia
    alcohol-or other psychoactive substance-induced amnestic disorder (F10, F13, F19 with .26, .96) names F13, which includes this code

Index to Diseases and InjuriesGuidance

Alphabetical index entries that point to this code.

Clinical ClassificationClinical

AHRQ’s CCSR groups this code into broader clinical categories.

CCSR MBD026
Mental and substance use disorders in remission
Default principal diagnosis: inpatient Yes · outpatient Yes

Convert F13.11 to ICD-9-CMHistory

The closest ICD-9-CM equivalents under the General Equivalence Mappings.

ICD-9-CM
305.43 Sed,hyp,anxiolytc ab-rem
Exact Match The mapping is direct, with no qualifiers.

Code History & ChangesHistory

Replacement F13.11 replaces the following previously assigned code(s):

  • F13.10 - Sedative, hypnotic or anxiolytic abuse, uncomplicated
FY 2019AddedAdded to the ICD-10-CM code setEffective October 1, 2018.
FY 2020–2026No changes
FY 2027CurrentCurrent code set, no changesEffective October 1, 2026 through September 30, 2027.

Questions About F13.11Overview

What is the ICD-10 code for sedative, hypnotic or anxiolytic abuse, in remission?

The ICD-10-CM code for sedative, hypnotic or anxiolytic abuse, in remission is F13.11 (sometimes written as F1311). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.

Is F13.11 (Sedative, hypnotic or anxiolytic-related abuse) a billable code?

Yes. This is a billable ICD-10-CM code, specific enough to report sedative, hypnotic or anxiolytic abuse, in remission on HIPAA-covered claims from October 1, 2026 through September 30, 2027.

What MS-DRG does F13.11 group to?

When sedative, hypnotic or anxiolytic abuse, in remission is the principal diagnosis on an inpatient stay, it groups to MS-DRG 894, 897, 895, 896, with relative weights from 0.6272 to 1.6610 depending on complications. Higher weights mean higher Medicare reimbursement.

Can F13.11 be reported with a code from F13.2?

Not as a rule. The Excludes1 note at F13.1, which applies to F13.11, lists "sedative, hypnotic or anxiolytic-related dependence (F13.2-)". An Excludes1 note means the excluded code is never reported together with this one; the only exception is when the two conditions are unrelated to each other (Official Guidelines, Section I.A.12.a).

What is the ICD-9 equivalent of F13.11?

Under the General Equivalence Mappings, sedative, hypnotic or anxiolytic abuse, in remission converts to ICD-9-CM 305.43 (sed,hyp,anxiolytc ab-rem). The mapping is a direct match.

What HCC is F13.11?

F13.11 (sedative, hypnotic or anxiolytic abuse, in remission) maps to CMS-HCC Category 138 (Drug Use Disorder, Mild, Uncomplicated, Except Cannabis), commonly written as HCC 138, in the CMS-HCC V28 model used for Medicare Advantage risk adjustment in payment year 2027. It mapped to HCC 56 under the retired V24 model. It also maps in the ESRD (V24) model. It does not map to any RxHCC in the Part D prescription drug model.

Does F13.11 risk-adjust for Medicare Advantage payment?

Yes. When documented and reported on a Medicare Advantage encounter, F13.11 adds a risk adjustment factor of about 0.423 to the beneficiary's RAF score for a community, non-dual, aged enrollee (published V28 weights range from 0.264 to 0.502 depending on the payment segment). A more severe related category (HCC 135, HCC 136, and HCC 137) supersedes it when both are reported. See the full factor table on the HCC 138 category page.