F11.21 ICD-10-CM Code: Opioid dependence, in remission
F11.21 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 · HCC coding software
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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)
F11.21
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceOpioid dependence, in remission
A person who was previously dependent on opioids but is now in remission, meaning they have stopped using opioids and are maintaining abstinence.
Buddy Insight
Opioid dependence, in remission indicates a patient with a history of opioid dependence who is currently in recovery.
CMS-HCC V28
MappedHCC 137
Coefficient HCC 137: 0.424 (Community Non-Dual Aged (CNA))
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
MappedHCC 082
Code-level coefficient reference
ESRD/PACE
MappedHCC 55
Code-level coefficient reference
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
Official- Opioid use disorder, moderate, in early remission
- Opioid use disorder, moderate, in sustained remission
- Opioid use disorder, severe, in early remission
- Opioid use disorder, severe, in sustained remission
Excludes 2
Official- symptoms, signs and abnormal clinical laboratory findings, not elsewhere classified (R00-R99)Inherited from F01-F99, F11.2
- opioid poisoning (T40.0-T40.2-)Inherited from F01-F99, F11.2
Related Codes
Includes
Official- disorders of psychological developmentInherited from F01-F99
Excludes 1
Official- opioid abuse (F11.1-)Inherited from F11.2
- opioid use, unspecified (F11.9-)Inherited from F11.2
Code First
OfficialNo Code First sequencing instructions are included in this display for F11.21. Check the code and parent instructions in the Code Book.
Use Additional
OfficialNo Use Additional Code instructions are included in this display for F11.21. Check the code and parent instructions in the Code Book.
Code Also
OfficialNo Code Also instructions are included in this display for F11.21. 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 F11.21 an HCC code?
Yes. F11.21 (Opioid dependence, in remission) 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: F11.21 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
- F11.21
- Description
- Opioid dependence, in remission
- 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
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 F11.21 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for F11.21
For F11.21, 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
F11.21 is the ICD-10-CM diagnosis code for opioid dependence, in remission. A person who was previously dependent on opioids but is now in remission, meaning they have stopped using opioids and are maintaining abstinence. F11.21 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, F11.21 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 F11.21; 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 dependence, in remission. Documentation must establish historical dependence and current sustained remission, maintenance therapy alone (methadone/buprenorphine) often does not meet 'in remission' criteria; the narrative must be explicit. For F11.21, 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 F11.21 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Opioid dependence, in remission. Documentation must establish historical dependence and current sustained remission, maintenance therapy alone (methadone/buprenorphine) often does not meet 'in remission' criteria; the narrative must be explicit.
- •Do not drop the code when the patient is stable on MAT, dependence-in-remission still risk-adjusts. But do distinguish 'in remission' from 'stable on methadone maintenance', the latter typically codes to F11.20.
- •The HCC persists in remission, so coders should not assume remission = no HCC.
Clinical Significance
Opioid dependence, in remission indicates a patient with a history of opioid dependence who is currently in recovery. This is particularly important given the opioid epidemic, as it identifies patients who need ongoing monitoring, relapse prevention, and continued medication-assisted treatment support. The diagnosis should be maintained as long as the provider documents ongoing remission.
Documentation Requirements
- ✓Provider documentation of prior opioid dependence
- ✓Statement that the patient is currently in remission
- ✓Duration of remission (early: less than 12 months; sustained: 12+ months)
- ✓Current medication-assisted treatment status (methadone, buprenorphine, naltrexone) if applicable
- ✓Recovery support services and monitoring plan
- ✓Relapse risk assessment
Commonly Confused Codes
- •F11.20: Opioid dependence, uncomplicated: use when dependence is active, not in remission
- •F11.11: Opioid abuse, in remission: use when the prior condition was abuse (not dependence)
- •Z87.898: Personal history of other specified conditions: NOT a substitute for remission codes
- •F11.90: Opioid use, unspecified: should not be used when dependence in remission is documented