ICD-10 F12.13
Billable / Specific HCC v28: 55Cannabis abuse with withdrawal
About ICD-10-CM F12.13
ICD-10-CM code F12.13 represents Cannabis abuse with withdrawal. This is a billable/specific code in the Mental, Behavioral, and Neurodevelopmental chapter (block F12). The 2026 edition of ICD-10-CM F12.13 became effective on October 1, 2025.
Coding Tips for F12.13
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
F12.13 is a CMS-HCC v28 risk-adjustment code (category 55). To count for the patient Risk Adjustment Factor (RAF), document the diagnosis with MEAT language each calendar year: Monitored, Evaluated, Assessed, Treated. A diagnosis on the problem list alone does not satisfy CMS RADV audit standards. Include the diagnosis in the assessment with current status and current treatment plan.
Medicare Advantage HCC Impact
Capture this diagnosis annually for accurate risk adjustment. Missed HCC captures are the #1 revenue leak in Medicare Advantage risk programs.
Medicare LCD Coverage for F12.13
Local Coverage Determinations (LCDs) from CMS MACs that list F12.13 as a covered diagnosis.
Showing top 10 of 369 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing F12.13.
5 Medicare
CPT Codes Commonly Billed with F12.13
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- 96121 CMS LCD: Billing and Coding: Psychiatric Partial Hospitalization Programs CMS LCD
- 96137 CMS LCD: Billing and Coding: Psychiatric Partial Hospitalization Programs CMS LCD
- 96116 CMS LCD: Billing and Coding: Psychiatric Partial Hospitalization Programs CMS LCD
- 96132 CMS LCD: Billing and Coding: Psychiatric Partial Hospitalization Programs CMS LCD
- 90838 CMS LCD: Billing and Coding: Psychiatric Partial Hospitalization Programs CMS LCD
- G0177 CMS LCD: Billing and Coding: Psychiatric Partial Hospitalization Programs CMS LCD
- 96146 CMS LCD: Billing and Coding: Psychiatric Partial Hospitalization Programs CMS LCD
- 90846 CMS LCD: Billing and Coding: Psychiatric Partial Hospitalization Programs CMS LCD
- G0411 CMS LCD: Billing and Coding: Psychiatric Partial Hospitalization Programs CMS LCD
- 96112 CMS LCD: Billing and Coding: Psychiatric Partial Hospitalization Programs CMS LCD
Codes Adjacent To F12.13
Other codes in section F10-F19 (Mental and behavioral disorders due to psychoactive substance use).
ICD-10 F12.13, Billing FAQ
Is ICD-10 code F12.13 billable? +
Yes, F12.13 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
Does F12.13 affect Medicare Advantage HCC risk adjustment? +
Yes. F12.13 maps to CMS-HCC v28 category 55. Capture this diagnosis annually for accurate Medicare Advantage risk score.
What CPT codes are commonly billed with F12.13? +
Procedures frequently paired with F12.13 include: 96121, 96137, 96116, 96132, 90838.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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