F11.10 ICD-10-CM Code: Opioid abuse, uncomplicated
F11.10 maps to CMS-HCC V28 138. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · free HCC coding tools
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FY 2026 Apr update / Mental, Behavioral and Neurodevelopmental disorders (F01-F99) / Mental and behavioral disorders due to psychoactive substance use (F10-F19)
F11.10
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceOpioid abuse, uncomplicated
A person is abusing opioids (such as heroin or prescription painkillers) without any complications like intoxication or withdrawal at this time.
Buddy Insight
Opioid abuse, uncomplicated identifies a pattern of opioid misuse that does not meet criteria for dependence and has no current complications.
CMS-HCC V28
MappedHCC 138
Code-level coefficient reference
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
N/A—
Not mapped
ESRD/PACE
MappedHCC 56
Code-level coefficient reference
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
Official- Opioid use disorder, mild
Excludes 2
Official- symptoms, signs and abnormal clinical laboratory findings, not elsewhere classified (R00-R99)Inherited from F01-F99
Related Codes
Includes
Official- disorders of psychological developmentInherited from F01-F99
Excludes 1
Official- opioid dependence (F11.2-)Inherited from F11.1
- opioid use, unspecified (F11.9-)Inherited from F11.1
Code First
OfficialNo Code First sequencing instructions are included in this display for F11.10. Check the code and parent instructions in the Code Book.
Use Additional
OfficialNo Use Additional Code instructions are included in this display for F11.10. Check the code and parent instructions in the Code Book.
Code Also
OfficialNo Code Also instructions are included in this display for F11.10. Check the code and parent instructions in the Code Book.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →
Is F11.10 an HCC code?
Yes. F11.10 (Opioid abuse, uncomplicated) maps to HCC 138, Drug Use Disorder, Mild, Uncomplicated, Except Cannabis under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.423. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.
Coder answer: F11.10 is billable and maps to V28 HCC 138, Drug Use Disorder, Mild, Uncomplicated, Except Cannabis. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.
- Code
- F11.10
- Description
- Opioid abuse, uncomplicated
- HCC (V28)
- HCC 138 — Drug Use Disorder, Mild, Uncomplicated, Except Cannabis
- RAF reference coefficient
- 0.423
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. Weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.
Work F11.10 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for F11.10
For F11.10, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.
- MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
- EEvaluate: test results, medication response, or physical findings reviewed by the provider
- AAssess: explicit mention in the assessment or plan with acknowledgment of status
- TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis
Coder workflow notes
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What This Code Means
F11.10 is the ICD-10-CM diagnosis code for opioid abuse, uncomplicated. A person is abusing opioids (such as heroin or prescription painkillers) without any complications like intoxication or withdrawal at this time. F11.10 sits in the ICD-10-CM chapter for mental, behavioral and neurodevelopmental disorders (f01-f99), within the section covering mental and behavioral disorders due to psychoactive substance use (f10-f19).
Under the CMS-HCC V28 risk adjustment model, F11.10 maps to Drug Use Disorder, Mild, Uncomplicated, Except Cannabis (HCC 138) with a source-labeled community, non-dual, aged reference coefficient of 0.423. No V24 mapping is shown for F11.10; use the applicable model and payment year when reviewing the V28 mapping. For CY2026 non-PACE Medicare Advantage, CMS uses 100% of the 2024 CMS-HCC model (V28). PACE uses a separate model blend. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.
Opioid abuse, uncomplicated. Provider documents a pattern of harmful opioid use without dependence features. Common in charts where the provider is addressing chronic-pain opioid misuse without formal dependence criteria. For F11.10, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.
HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for F11.10 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Opioid abuse, uncomplicated. Provider documents a pattern of harmful opioid use without dependence features. Common in charts where the provider is addressing chronic-pain opioid misuse without formal dependence criteria.
- •Do not confuse F11.10 with F11.20. If the narrative supports tolerance, withdrawal, or loss of control, dependence (F11.20) is the correct code. Also, do not use F11.10 for legitimate long-term opioid therapy without abuse features, there is no ICD code for appropriate therapy.
- •Unlike uncomplicated alcohol abuse (no HCC), uncomplicated drug abuse maps to the mild drug-use HCC 138. Opioid-use coding carries higher audit scrutiny; documentation specificity matters.
Clinical Significance
Opioid abuse, uncomplicated identifies a pattern of opioid misuse that does not meet criteria for dependence and has no current complications. This is a critical diagnosis in the opioid epidemic context, as early identification of abuse patterns enables intervention before progression to dependence. It captures a population at risk for escalating use and overdose.
Documentation Requirements
- ✓Provider documentation using the term 'abuse' or language consistent with abuse criteria (recurrent use causing problems but not dependent)
- ✓Specification of opioid type if documented (prescription opioids, heroin, synthetic opioids)
- ✓Evidence that the pattern does not meet dependence criteria (no tolerance, withdrawal, compulsive use)
- ✓No current intoxication, withdrawal, or other complications documented
- ✓Assessment and treatment/referral plan
Commonly Confused Codes
- •F11.20: Opioid dependence, uncomplicated: use when dependence criteria are met (tolerance, withdrawal, compulsive use)
- •F11.10 vs F11.11: F11.11 is abuse in remission; F11.10 is active uncomplicated abuse
- •F11.90: Opioid use, unspecified, uncomplicated: use when the use pattern cannot be classified as abuse or dependence
- •Z72.89: Other problems related to lifestyle: NOT appropriate for documented opioid abuse