F11.10 ICD-10-CM Code: Opioid abuse, uncomplicated
HCC Buddy Code Card
Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.
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
RAF 0.476
CMS-HCC V24
MappedHCC 56
RAF 0.0
ACA/HHS
00
RAF 0
ESRD/PACE
MappedHCC 56
RAF 0.0
RXHCC
00
RAF 0
Code Trumping
Basket needed
Code Book Path
Inclusion Terms
Official- Opioid use disorder, mild
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for F11.10 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for F11.10 in this effective period.
Excludes 1
Official- opioid dependence (F11.2-)
- opioid use, unspecified (F11.9-)
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for F11.10 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for F11.10 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for F11.10 in this effective period.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.
Is F11.10 an HCC code?
Yes. F11.10 maps to Drug Use Disorder/Substance Use Disorder, Mild under the CMS-HCC V28 risk adjustment model (and Drug/Alcohol Abuse, Without Dependence under V24).
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.
MEAT Criteria for F11.10
For F11.10to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically, it has to be re-documented and supported each calendar year.
- 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
Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed F11.10 during that encounter, not just copy-forwarded from a problem list.
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/Substance Use Disorder, Mild (HCC 138) with a community, non-dual, aged base RAF weight of 0.476. Under the older CMS-HCC V24 model, F11.10 maps to Drug/Alcohol Abuse, Without Dependence (HCC 56) with a community, non-dual, aged base RAF weight of 0.000. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.
This code indicates abuse without intoxication or withdrawal; if either is present, use a more specific code. Because F11.10 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. 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, RAF weights, 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
- •This code indicates abuse without intoxication or withdrawal; if either is present, use a more specific code
- •Distinguish between F11.10 (abuse) and F11.20 (dependence) based on whether the patient meets criteria for substance dependence
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