ICD-10 F12.21
Billable / Specific HCC v28: 55Cannabis dependence, in remission
About ICD-10-CM F12.21
ICD-10-CM code F12.21 represents Cannabis dependence, in remission. This is a billable/specific code in the Mental, Behavioral, and Neurodevelopmental chapter (block F12). The 2026 edition of ICD-10-CM F12.21 became effective on October 1, 2025.
Coding Tips for F12.21
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
F12.21 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.
Inclusion Terms / Approximate Synonyms
Clinical terms and conditions classified under F12.21. Per CMS ICD-10-CM Tabular 2026.
- Cannabis use disorder, moderate, in early remission
- Cannabis use disorder, moderate, in sustained remission
- Cannabis use disorder, severe, in early remission
- Cannabis use disorder, severe, in sustained remission
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 F12.21
Local Coverage Determinations (LCDs) from CMS MACs that list F12.21 as a covered diagnosis.
Showing top 10 of 181 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing F12.21.
5 Medicare
CPT Codes Commonly Billed with F12.21
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
We don't have CPT pairings indexed for this specific code yet. Use the CPT search above to find common procedures, or check your payer's published medical policy for code-specific guidance.
Convert F12.21 to ICD-9-CM
Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.
| ICD-10 | ICD-9 | Mapping Flags |
|---|---|---|
| F12.21 | 30433 | 00000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To F12.21
Other codes in section F10-F19 (Mental and behavioral disorders due to psychoactive substance use).
ICD-10 F12.21, Billing FAQ
Is ICD-10 code F12.21 billable? +
Yes, F12.21 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
What other names or terms map to F12.21? +
ICD-10 F12.21 includes: Cannabis use disorder, moderate, in early remission; Cannabis use disorder, moderate, in sustained remission; Cannabis use disorder, severe, in early remission, and 1 more clinical synonyms.
Does F12.21 affect Medicare Advantage HCC risk adjustment? +
Yes. F12.21 maps to CMS-HCC v28 category 55. Capture this diagnosis annually for accurate Medicare Advantage risk score.
What ICD-9 codes does F12.21 map to? +
Per CMS GEMs, F12.21 maps to ICD-9 codes: 30433. Useful for legacy data review and historical claim analysis.
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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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