ICD-10 F11.188
Billable / Specific HCC v28: 55Opioid abuse with other opioid-induced disorder
About ICD-10-CM F11.188
ICD-10-CM code F11.188 represents Opioid abuse with other opioid-induced disorder. This is a billable/specific code in the Mental, Behavioral, and Neurodevelopmental chapter (block F11). The 2026 edition of ICD-10-CM F11.188 became effective on October 1, 2025.
Coding Tips for F11.188
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
F11.188 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 F11.188. Per CMS ICD-10-CM Tabular 2026.
- Opioid-associated amnestic syndrome with opioid abuse
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 F11.188
Local Coverage Determinations (LCDs) from CMS MACs that list F11.188 as a covered diagnosis.
Showing top 10 of 380 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing F11.188.
1 Cigna
5 Medicare
CPT Codes Commonly Billed with F11.188
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- 96121 CMS LCD: Billing and Coding: Psychiatric Partial Hospitalization Programs CMS LCD
- 96137 CMS LCD: Billing and Coding: Psychiatric Partial Hospitalization Programs CMS LCD
- 96116 CMS LCD: Billing and Coding: Psychiatric Partial Hospitalization Programs CMS LCD
- 96132 CMS LCD: Billing and Coding: Psychiatric Partial Hospitalization Programs CMS LCD
- 90838 CMS LCD: Billing and Coding: Psychiatric Partial Hospitalization Programs CMS LCD
- G0177 CMS LCD: Billing and Coding: Psychiatric Partial Hospitalization Programs CMS LCD
- 96146 CMS LCD: Billing and Coding: Psychiatric Partial Hospitalization Programs CMS LCD
- 90846 CMS LCD: Billing and Coding: Psychiatric Partial Hospitalization Programs CMS LCD
- G0411 CMS LCD: Billing and Coding: Psychiatric Partial Hospitalization Programs CMS LCD
- 96112 CMS LCD: Billing and Coding: Psychiatric Partial Hospitalization Programs CMS LCD
Convert F11.188 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 |
|---|---|---|
| F11.188 | 29289 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To F11.188
Other codes in section F10-F19 (Mental and behavioral disorders due to psychoactive substance use).
ICD-10 F11.188, Billing FAQ
Is ICD-10 code F11.188 billable? +
Yes, F11.188 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 F11.188? +
ICD-10 F11.188 includes: Opioid-associated amnestic syndrome with opioid abuse.
Does F11.188 affect Medicare Advantage HCC risk adjustment? +
Yes. F11.188 maps to CMS-HCC v28 category 55. Capture this diagnosis annually for accurate Medicare Advantage risk score.
What CPT codes are commonly billed with F11.188? +
Procedures frequently paired with F11.188 include: 96121, 96137, 96116, 96132, 90838.
What ICD-9 codes does F11.188 map to? +
Per CMS GEMs, F11.188 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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