ICD-10 F11.122
Billable / Specific HCC v28: 55Opioid abuse with intoxication with perceptual disturbance
About ICD-10-CM F11.122
ICD-10-CM code F11.122 represents Opioid abuse with intoxication with perceptual disturbance. This is a billable/specific code in the Mental, Behavioral, and Neurodevelopmental chapter (block F11). The 2026 edition of ICD-10-CM F11.122 became effective on October 1, 2025.
Coding Tips for F11.122
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
F11.122 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 F11.122
Local Coverage Determinations (LCDs) from CMS MACs that list F11.122 as a covered diagnosis.
Showing top 10 of 281 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing F11.122.
1 Cigna
5 Medicare
CPT Codes Commonly Billed with F11.122
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 F11.122 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 |
|---|---|---|
| F11.122 | 29289 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To F11.122
Other codes in section F10-F19 (Mental and behavioral disorders due to psychoactive substance use).
ICD-10 F11.122, Billing FAQ
Is ICD-10 code F11.122 billable? +
Yes, F11.122 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
Does F11.122 affect Medicare Advantage HCC risk adjustment? +
Yes. F11.122 maps to CMS-HCC v28 category 55. Capture this diagnosis annually for accurate Medicare Advantage risk score.
What CPT codes are commonly billed with F11.122? +
Procedures frequently paired with F11.122 include: G2215, G2073, G2067, G2079, G0137.
What ICD-9 codes does F11.122 map to? +
Per CMS GEMs, F11.122 maps to ICD-9 codes: 29289. 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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