FY2027 ICD-10-CM reference

F11.11: Opioid abuse, in remission

By the HCC Buddy Coding Team

The official ICD-10-CM descriptor is Opioid abuse, in remission. The FY2027 annual edition starts October 1, 2026. Check the edition that applies to the encounter or inpatient discharge, including any April update.

Billable code. Verified against the official FY2027 order file.

CMS-HCC V28

HCC 138: Drug Use Disorder, Mild, Uncomplicated, Except Cannabis · RAF 0.423, Community Non-Dual Aged (CNA)

Payment year 2027, 2026 dates of service. HCC from the CMS 2027 Initial ICD-10-CM Mappings; RAF from the CMS-HCC V28 relative factors. For 2027 dates of service, CMS has not yet published the payment year 2028 mappings.

CMS-HCC V24

Not used for payment year 2027 Medicare Advantage payment

ESRD

HCC 56: Substance Use Disorder/Mild/Except Alcohol and Cannabis

Coefficient pending: payment year 2027 coefficients for this model are not yet verified, so no RAF is shown. Mapping: PY2026 CMS mapping; CMS 2027 initial file unchanged.

PACE

Source verification pending

RxHCC

No category in the PY2026 CMS mapping; CMS 2027 initial file unchanged

HHS-HCC

Source verification pending

FY2027 Tabular instructions

Instructions below include applicable chapter, section and parent-code notes. Each note identifies where it appears in the official source.

Includes

disorders of psychological development

Source: F01-F99 (chapter, inherited).

Excludes2

symptoms, signs and abnormal clinical laboratory findings, not elsewhere classified (R00-R99)

Source: F01-F99 (chapter, inherited).

Excludes1

opioid dependence (F11.2-)

Source: F11.1 (self, inherited).

Excludes1

opioid use, unspecified (F11.9-)

Source: F11.1 (self, inherited).

Instructional note

Opioid use disorder, mild, in early remission

Source: F11.11 (self, direct).

Instructional note

Opioid use disorder, mild, in sustained remission

Source: F11.11 (self, direct).

Source: CMS FY2027 Tabular List and Alphabetic Index.

Open Tabular instructions and code details

Compare the FY2027 additions, removals and billable-status changes

What does F11.11 mean in FY2027?

Is F11.11 billable in FY2027?

The FY2027 order file marks F11.11 as billable. Check the complete Tabular instructions and documentation before assigning it.

Does F11.11 map to an HCC?

In the CMS 2027 Initial ICD-10-CM Mappings (payment year 2027, 2026 dates of service), F11.11 maps to CMS-HCC V28 HCC 138 (Drug Use Disorder, Mild, Uncomplicated, Except Cannabis). For 2027 dates of service, CMS has not yet published the payment year 2028 mappings. Under the PY2026 CMS mapping; CMS 2027 initial file unchanged: ESRD HCC 56; no RxHCC category. Coefficients for these models are pending verification for payment year 2027. CMS-HCC V24: not used for payment year 2027 Medicare Advantage payment (CMS CY 2027 Rate Announcement). PACE and HHS-HCC mappings are still pending verification for FY2027.

Source: CMS FY2027 ICD-10-CM order file. Payment model: CMS CY 2027 Rate Announcement. Read the FY2027 Official Guidelines.

Review the FY2026 April edition