What is ICD-10 code F11.13?

F11.13 is the ICD-10-CM diagnosis code for Opioid abuse with withdrawal. A person is abusing opioids and is experiencing withdrawal symptoms (such as body aches, sweating, anxiety, and cravings) from reducing or stopping opioid use. F11.13 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. F11.13 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. F11.13 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. F11.13 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

Which HCC does F11.13 map to under V28?

F11.13 maps to CMS-HCC V28 HCC 137 (Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications). The category numbers, labels, and conditions come from the CMS-HCC V28 model file for payment year 2026.

2026 ICD-10-CM F11.13: Opioid abuse

F11.13 maps to CMS-HCC V28 137. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · free HCC coding tools

ICD-10-CM Code View

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Code lookupF11.13

Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Mental, Behavioral and Neurodevelopmental disorders (F01-F99) / Mental and behavioral disorders due to psychoactive substance use (F10-F19)

F11.13

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Opioid abuse with withdrawal

A person is abusing opioids and is experiencing withdrawal symptoms (such as body aches, sweating, anxiety, and cravings) from reducing or stopping opioid use.

Buddy Insight

Opioid abuse with withdrawal indicates a patient with an opioid abuse pattern is experiencing withdrawal symptoms upon cessation or reduction of use.

Overview Risk Models Code Book Documentation Audit Notes Edition comparison

CMS-HCC V28

Mapped

HCC 137

Drug Use Disorder, Moderate/S...

Code-level coefficient reference

CMS-HCC V24

Historical

Not used for standard CY2026 Medicare Advantage payment. Select a historical period to review V24.

Not used for CY2026 payment

ACA/HHS

Mapped

HCC 082

HHS-HCC 082 adult, RAF varies...

Code-level coefficient reference

ESRD/PACE

Mapped

HCC 55

Substance Use Disorder/Modera...

Code-level coefficient reference

RXHCC

N/A

—

Not risk-adjusted for this model/period.

Not mapped

Code Book Path

Official

Inclusion Terms

Official

No inclusion terms are included in this display for F11.13. Check the code and parent instructions in the Code Book.

Excludes 2

Official

symptoms, signs and abnormal clinical laboratory findings, not elsewhere classified (R00-R99)Inherited from F01-F99

Related Codes

Official

F11.10Opioid abuse, uncomplicated F11.11Opioid abuse, in remission F11.12Opioid abuse with intoxication F11.14Opioid abuse with opioid-induced mood disorder F11.15Opioid abuse with opioid-induced psychotic disorder

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

Official

No Code First sequencing instructions are included in this display for F11.13. Check the code and parent instructions in the Code Book.

Use Additional

Official

No Use Additional Code instructions are included in this display for F11.13. Check the code and parent instructions in the Code Book.

Code Also

Official

No Code Also instructions are included in this display for F11.13. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance

Provider documentation of opioid abuse pattern

Documentation of active withdrawal symptoms (muscle aches, lacrimation, rhinorrhea, piloerection, sweating, diarrhea, yawning, insomnia, anxiety)

Temporal relationship between opioid cessation/reduction and symptom onset

Clinical Opiate Withdrawal Scale (COWS) score if available

MEAT Support

HCC Buddy guidance

Provider documentation of opioid abuse pattern

Documentation of active withdrawal symptoms (muscle aches, lacrimation, rhinorrhea, piloerection, sweating, diarrhea, yawning, insomnia, anxiety)

Temporal relationship between opioid cessation/reduction and symptom onset

Clinical Opiate Withdrawal Scale (COWS) score if available

Audit Caution

HCC Buddy guidance

Confusing withdrawal with intoxication — they are opposite clinical states

Coding dependence with withdrawal when the documented pattern is abuse, not dependence

Not recognizing withdrawal symptoms when described in non-standard terminology

Failing to capture withdrawal as a current condition when it is being actively managed

Common Mistakes

HCC Buddy guidance

F11.23 — Opioid dependence with withdrawal: use when dependence (not abuse) is documented

F11.93 — Opioid use, unspecified with withdrawal: use when use pattern is unspecified

F11.120 — Opioid abuse with intoxication, uncomplicated: withdrawal is the opposite of intoxication — do not confuse

F11.10 — Opioid abuse, uncomplicated: use when there is no active withdrawal or other complications

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 F11.13 an HCC code?

Yes. F11.13 (Opioid abuse with withdrawal) maps to HCC 137, Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.424. 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: F11.13 is billable and maps to V28 HCC 137, Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code: F11.13
Description: Opioid abuse with withdrawal
HCC (V28): HCC 137 — Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications
RAF reference coefficient: 0.424
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 137, Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications

0.424

ESRDHCC 55, Substance Use Disorder/Moderate/Severe/Substance Use with Complications

Not separately weighted

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 F11.13 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for F11.13

For F11.13, 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

F11.13 is the ICD-10-CM diagnosis code for opioid abuse with withdrawal. A person is abusing opioids and is experiencing withdrawal symptoms (such as body aches, sweating, anxiety, and cravings) from reducing or stopping opioid use. F11.13 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, F11.13 maps to Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications (HCC 137) with a source-labeled community, non-dual, aged reference coefficient of 0.424. No V24 mapping is shown for F11.13; 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.

Withdrawal symptoms must be documented to support this code; common symptoms include muscle aches, insomnia, and anxiety. For F11.13, 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 F11.13 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Withdrawal symptoms must be documented to support this code; common symptoms include muscle aches, insomnia, and anxiety
•Distinguish between abuse with withdrawal (F11.13) and dependence with withdrawal (F11.23)

Clinical Significance

Opioid abuse with withdrawal indicates a patient with an opioid abuse pattern is experiencing withdrawal symptoms upon cessation or reduction of use. Opioid withdrawal, while rarely life-threatening, causes significant distress including muscle aches, gastrointestinal symptoms, anxiety, and intense cravings. This code captures a critical intervention point for treatment engagement.

Documentation Requirements

✓Provider documentation of opioid abuse pattern
✓Documentation of active withdrawal symptoms (muscle aches, lacrimation, rhinorrhea, piloerection, sweating, diarrhea, yawning, insomnia, anxiety)
✓Temporal relationship between opioid cessation/reduction and symptom onset
✓Clinical Opiate Withdrawal Scale (COWS) score if available
✓Treatment plan for withdrawal management
✓Assessment for medication-assisted treatment candidacy

Commonly Confused Codes

•F11.23: Opioid dependence with withdrawal: use when dependence (not abuse) is documented
•F11.93: Opioid use, unspecified with withdrawal: use when use pattern is unspecified
•F11.120: Opioid abuse with intoxication, uncomplicated: withdrawal is the opposite of intoxication: do not confuse
•F11.10: Opioid abuse, uncomplicated: use when there is no active withdrawal or other complications