ICD-10 F11.11
Billable / Specific HCC v28: 56Opioid abuse, in remission
About ICD-10-CM F11.11
ICD-10-CM code F11.11 represents Opioid abuse, in remission. This is a billable/specific code in the Mental, Behavioral, and Neurodevelopmental chapter (block F11). The 2026 edition of ICD-10-CM F11.11 became effective on October 1, 2025.
Coding Tips for F11.11
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
F11.11 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 F11.11. Per CMS ICD-10-CM Tabular 2026.
- Opioid use disorder, mild, in early remission
- Opioid use disorder, mild, 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 F11.11
Local Coverage Determinations (LCDs) from CMS MACs that list F11.11 as a covered diagnosis.
Showing top 10 of 257 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing F11.11.
5 Medicare
CPT Codes Commonly Billed with F11.11
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- G0480 CMS LCD: Billing and Coding: Urine Drug Testing CMS LCD
- 80306 CMS LCD: Billing and Coding: Urine Drug Testing CMS LCD
- G0482 CMS LCD: Billing and Coding: Urine Drug Testing CMS LCD
- 0603U CMS LCD: Billing and Coding: Urine Drug Testing CMS LCD
- 80305 CMS LCD: Billing and Coding: Urine Drug Testing CMS LCD
- G0659 CMS LCD: Billing and Coding: Urine Drug Testing CMS LCD
- G0483 CMS LCD: Billing and Coding: Urine Drug Testing CMS LCD
- 80307 CMS LCD: Billing and Coding: Urine Drug Testing CMS LCD
- G0481 CMS LCD: Billing and Coding: Urine Drug Testing CMS LCD
- G2215 CMS LCD: Billing and Coding: Opioid Treatment Programs CMS LCD
Codes Adjacent To F11.11
Other codes in section F10-F19 (Mental and behavioral disorders due to psychoactive substance use).
ICD-10 F11.11, Billing FAQ
Is ICD-10 code F11.11 billable? +
Yes, F11.11 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 F11.11? +
ICD-10 F11.11 includes: Opioid use disorder, mild, in early remission; Opioid use disorder, mild, in sustained remission.
Does F11.11 affect Medicare Advantage HCC risk adjustment? +
Yes. F11.11 maps to CMS-HCC v28 category 56. Capture this diagnosis annually for accurate Medicare Advantage risk score.
What CPT codes are commonly billed with F11.11? +
Procedures frequently paired with F11.11 include: G0480, 80306, G0482, 0603U, 80305.
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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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