ICD-10 F11.10
Billable / Specific HCC v28: 56Opioid abuse, uncomplicated
About ICD-10-CM F11.10
ICD-10-CM code F11.10 represents Opioid abuse, uncomplicated. This is a billable/specific code in the Mental, Behavioral, and Neurodevelopmental chapter (block F11). The 2026 edition of ICD-10-CM F11.10 became effective on October 1, 2025.
Coding Tips for F11.10
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
F11.10 is a CMS-HCC v28 risk-adjustment code (category 56). 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 F11.10. Per CMS ICD-10-CM Tabular 2026.
- Opioid use disorder, mild
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 F11.10
Local Coverage Determinations (LCDs) from CMS MACs that list F11.10 as a covered diagnosis.
Showing top 10 of 303 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing F11.10.
4 Aetna
2 Cigna
5 Medicare
CPT Codes Commonly Billed with F11.10
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- G2215 CMS LCD: Billing and Coding: Opioid Treatment Programs CMS LCD
- G2073 CMS LCD: Billing and Coding: Opioid Treatment Programs CMS LCD
- G2067 CMS LCD: Billing and Coding: Opioid Treatment Programs CMS LCD
- G2079 CMS LCD: Billing and Coding: Opioid Treatment Programs CMS LCD
- G0137 CMS LCD: Billing and Coding: Opioid Treatment Programs CMS LCD
- G2080 CMS LCD: Billing and Coding: Opioid Treatment Programs CMS LCD
- G2075 CMS LCD: Billing and Coding: Opioid Treatment Programs CMS LCD
- G2068 CMS LCD: Billing and Coding: Opioid Treatment Programs CMS LCD
- G2074 CMS LCD: Billing and Coding: Opioid Treatment Programs CMS LCD
- G0534 CMS LCD: Billing and Coding: Opioid Treatment Programs CMS LCD
Convert F11.10 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 |
|---|---|---|
| F11.10 | 30550 | 10000 |
| F11.10 | 30551 | 10000 |
| F11.10 | 30552 | 10000 |
| F11.10 | 30553 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To F11.10
Other codes in section F10-F19 (Mental and behavioral disorders due to psychoactive substance use).
ICD-10 F11.10, Billing FAQ
Is ICD-10 code F11.10 billable? +
Yes, F11.10 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 F11.10? +
ICD-10 F11.10 includes: Opioid use disorder, mild.
Does F11.10 affect Medicare Advantage HCC risk adjustment? +
Yes. F11.10 maps to CMS-HCC v28 category 56. Capture this diagnosis annually for accurate Medicare Advantage risk score.
What CPT codes are commonly billed with F11.10? +
Procedures frequently paired with F11.10 include: G2215, G2073, G2067, G2079, G0137.
What ICD-9 codes does F11.10 map to? +
Per CMS GEMs, F11.10 maps to ICD-9 codes: 30550, 30551, 30552, 30553. 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 June 1, 2026.
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