CPT (Current Procedural Terminology) codes are five-digit numeric codes used to describe medical, surgical, and diagnostic services. They are maintained by the American Medical Association and used by healthcare providers, insurers, and Medicare for billing and reimbursement.

What is the difference between facility and non-facility rates?

Non-facility (office) rates are what Medicare pays when a service is performed in a physician's office. Facility rates are lower because when a service is performed in a hospital or ambulatory surgery center, the facility bills separately for overhead costs like equipment and supplies.

RVU stands for Relative Value Unit. Medicare uses RVUs to measure the value of physician services based on three components: physician work, practice expense, and malpractice cost. Total RVUs are multiplied by the conversion factor ($33.40 in 2026) to calculate the Medicare payment amount.

Is F10.131 a billable ICD-10-CM code?

Yes. F10.131 (Alcohol abuse with withdrawal delirium) is a billable/specific ICD-10-CM code and can be reported on a claim when the documentation supports it.

What HCC does F10.131 map to?

F10.131 maps to HCC136 (Alcohol Use with Psychotic Complications) in the CMS-HCC V28 risk-adjustment model (Medicare Advantage / Part C) for payment year 2026. Risk-adjustable diagnoses must be documented and resubmitted each year — and survive the CMS-HCC hierarchy and edits — to count toward a member's risk score.

ICD-10-CM · F01–F99BillableHCC136

ICD-10-CM Code F10.131

Alcohol abuse with withdrawal delirium

Source: CMS ICD-10-CM FY2026Effective October 1, 2025Reviewed by the D3rx Clinical Billing Team

Diagnosis information

Billable

Yes

Valid for claim submission

Chapter

F01–F99

Mental, behavioral and neurodevelopmental disorders

Risk adjustment

HCC

HCC136

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HCC risk adjustment (CMS-HCC V28)

HCC136Alcohol Use with Psychotic Complications

Model CMS-HCC V28Payment year 2026

In CMS's Hierarchical Condition Category (HCC) model — the risk-adjustment model for Medicare Advantage (Part C) — a documented and submitted F10.131 may contribute to a member's risk score (subject to the CMS-HCC hierarchy and edits), which helps drive the plan's capitated payment for that patient. To count, the diagnosis must be supported to the MEAT standard (Monitored, Evaluated, Assessed, Treated) and reported on an eligible face-to-face encounter at least once each calendar year — risk scores reset annually.

More codes in the F10 category

Other billable ICD-10-CM codes in the same category as F10.131. Coding to the highest specificity the documentation supports is what keeps a claim clean — pick the child code that most precisely matches the diagnosis.

F10.10Alcohol abuse, uncomplicated
F10.11Alcohol abuse, in remission
F10.120Alcohol abuse with intoxication, uncomplicated
F10.121Alcohol abuse with intoxication delirium
F10.129Alcohol abuse with intoxication, unspecified
F10.130Alcohol abuse with withdrawal, uncomplicated
F10.132Alcohol abuse with withdrawal with perceptual disturbance
F10.139Alcohol abuse with withdrawal, unspecified
F10.14Alcohol abuse with alcohol-induced mood disorder
F10.150Alcohol abuse with alcohol-induced psychotic disorder with delusions
F10.151Alcohol abuse with alcohol-induced psychotic disorder with hallucinations
F10.159Alcohol abuse with alcohol-induced psychotic disorder, unspecified

Documentation & coding notes

F10.131 is a billable/specific ICD-10-CM code — it can be reported as a primary or secondary diagnosis when the documentation supports it. Code to the highest level of specificity the record allows.
F10.131 is risk-adjustable: it maps to HCC136 in the CMS-HCC V28 model (payment year 2026), the risk-adjustment model for Medicare Advantage (Part C). For the diagnosis to contribute to a member's risk score it must survive the CMS-HCC hierarchy and edits, be documented to the MEAT standard (Monitored, Evaluated, Assessed, Treated), and be submitted on an eligible face-to-face encounter at least once per calendar year.
Always verify the code against the current ICD-10-CM Official Guidelines and the payer's coverage policy before submitting — coverage, medical necessity edits, and sequencing rules vary by payer.

Related F01–F99 codes

F41.9 F32.9 F33.9 F41.1 F90.9 F17.210 F10.20

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Medical coding disclaimer

ICD-10-CM codes and descriptions shown are from the CMS FY2026 official code set and HCC mappings from the CMS-HCC V28 model (payment year 2026), shown for educational reference. Official Guidelines, payer coverage, medical-necessity edits, and sequencing rules vary. Always verify with the current ICD-10-CM Official Guidelines and the payer before submitting claims. D3rx is not responsible for coding or billing outcomes.