What is ICD-10 code F11.23?

F11.23 is the ICD-10-CM diagnosis code for Opioid dependence with withdrawal. It belongs to the ICD-10-CM chapter for mental, behavioral and neurodevelopmental disorders (f01-f99). F11.23 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. F11.23 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. F11.23 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. F11.23 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.

What is the V28 vs V24 difference for F11.23?

CMS phased in the V28 risk adjustment model over payment years 2024 (33%), 2025 (67%), and 2026 (100%), replacing V24. V28 consolidates HCC categories, removes some lower-acuity conditions, and recalibrates RAF weights across the entire model. For F11.23, V28 maps to Drug Use Disorder/Substance Use Disorder, Moderate/Severe at RAF 0.358 while V24 mapped to Drug/Alcohol Dependence at RAF 0.334. Both models can still appear in legacy data and in payer-specific lookback periods.

What should coders know when reporting F11.23?

Ensure documentation clearly indicates both the opioid dependence AND the active withdrawal state; withdrawal alone without documented dependence would use a different code Specify the type of opioid if documented (heroin, prescription opioids, synthetic opioids) as this may affect treatment planning and should be reflected in more specific coding when available Because F11.23 maps to a payment HCC, the documentation must also satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's risk adjustment score.

F11.23 ICD-10 Code: Opioid dependence

ICD-10-CM Code View

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Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.

Code lookupF11.23Effective 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)

F11.23

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

Opioid dependence with withdrawal

This code describes a patient who is dependent on opioids and is currently experiencing withdrawal symptoms, which occur when opioid use is reduced or stopped. Withdrawal can cause physical discomfort and psychological symptoms like anxiety, pain, and cravings.

Buddy Insight

Opioid dependence with withdrawal is a critical diagnosis indicating a physiologically dependent patient experiencing withdrawal symptoms upon cessation or reduction of opioid use.

CMS-HCC V28

Mapped

HCC 137

Drug Use Disorder/Substance U...

RAF 0.358

CMS-HCC V24

Mapped

HCC 55

Drug/Alcohol Dependence

RAF 0.334

ACA/HHS

Not risk-adjusted for this model/period.

RAF 0

ESRD/PACE

Mapped

HCC 55

Drug/Alcohol Dependence

RAF 0.0

RXHCC

Not risk-adjusted for this model/period.

RAF 0

Code Trumping

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Code Book Path

Official

F11Opioid related disorders

F11.2Opioid dependence

F11.23Opioid dependence with withdrawal

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for F11.23 in this effective period.

Excludes 2

Official

opioid poisoning (T40.0-T40.2-)

Related Child Codes

Official

F11.20Opioid dependence, uncomplicated

F11.21Opioid dependence, in remission

F11.22Opioid dependence with intoxication

F11.24Opioid dependence with opioid-induced mood disorder

F11.25Opioid dependence with opioid-induced psychotic disorder

Includes

Official

ICD-10-CM does not list Includes notes for F11.23 in this effective period.

Excludes 1

Official

opioid dependence with intoxication (F11.22-)

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for F11.23 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for F11.23 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for F11.23 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Provider documentation of opioid dependence

Documentation of active withdrawal symptoms (myalgia, lacrimation, rhinorrhea, diaphoresis, piloerection, nausea, vomiting, diarrhea, insomnia, anxiety, restlessness)

Clinical Opiate Withdrawal Scale (COWS) score if available

Temporal relationship between opioid cessation/reduction and symptom onset

MEAT Support

HCC Buddy guidance

Provider documentation of opioid dependence

Documentation of active withdrawal symptoms (myalgia, lacrimation, rhinorrhea, diaphoresis, piloerection, nausea, vomiting, diarrhea, insomnia, anxiety, restlessness)

Clinical Opiate Withdrawal Scale (COWS) score if available

Temporal relationship between opioid cessation/reduction and symptom onset

Audit Caution

HCC Buddy guidance

Confusing withdrawal with intoxication — they present with opposite clinical features

Using the abuse code when dependence is the established pattern

Not recognizing withdrawal symptoms in patients presenting with 'flu-like symptoms' who have an opioid history

Coding withdrawal when the patient is actually in maintenance therapy without active withdrawal symptoms

Common Mistakes

HCC Buddy guidance

F11.13 — Opioid abuse with withdrawal: use when abuse (not dependence) is the documented pattern

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

F11.20 — Opioid dependence, uncomplicated: use when no active withdrawal is present

F11.220 — Opioid dependence with intoxication: withdrawal and intoxication are mutually exclusive states

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 F11.23 an HCC code?

Yes. F11.23 maps to Drug Use Disorder/Substance Use Disorder, Moderate/Severe under the CMS-HCC V28 risk adjustment model (and Drug/Alcohol Dependence under V24).

HCC Category Mapping

V28HCC 137, Drug Use Disorder/Substance Use Disorder, Moderate/Severe

0.358

V24HCC 55, Drug/Alcohol Dependence

0.334

ESRDHCC 55, Drug/Alcohol Dependence

0.000

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 F11.23

For F11.23to 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 F11.23 during that encounter, not just copy-forwarded from a problem list.

What This Code Means

F11.23 is the ICD-10-CM diagnosis code for opioid dependence with withdrawal. This code describes a patient who is dependent on opioids and is currently experiencing withdrawal symptoms, which occur when opioid use is reduced or stopped. Withdrawal can cause physical discomfort and psychological symptoms like anxiety, pain, and cravings. F11.23 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, F11.23 maps to Drug Use Disorder/Substance Use Disorder, Moderate/Severe (HCC 137) with a community, non-dual, aged base RAF weight of 0.358. Under the older CMS-HCC V24 model, F11.23 maps to Drug/Alcohol Dependence (HCC 55) with a community, non-dual, aged base RAF weight of 0.334. 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.

Ensure documentation clearly indicates both the opioid dependence AND the active withdrawal state; withdrawal alone without documented dependence would use a different code. Because F11.23 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 F11.23 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Ensure documentation clearly indicates both the opioid dependence AND the active withdrawal state; withdrawal alone without documented dependence would use a different code
•Specify the type of opioid if documented (heroin, prescription opioids, synthetic opioids) as this may affect treatment planning and should be reflected in more specific coding when available

Clinical Significance

Opioid dependence with withdrawal is a critical diagnosis indicating a physiologically dependent patient experiencing withdrawal symptoms upon cessation or reduction of opioid use. Opioid withdrawal causes intense physical and psychological distress and is a major driver of relapse and continued use. This code captures a high-acuity clinical state requiring active medical management.

Documentation Requirements

✓Provider documentation of opioid dependence
✓Documentation of active withdrawal symptoms (myalgia, lacrimation, rhinorrhea, diaphoresis, piloerection, nausea, vomiting, diarrhea, insomnia, anxiety, restlessness)
✓Clinical Opiate Withdrawal Scale (COWS) score if available
✓Temporal relationship between opioid cessation/reduction and symptom onset
✓Type of opioid if documented
✓Withdrawal management plan (medication-assisted treatment, supportive care)
✓Assessment for medication-assisted treatment candidacy

Excludes 1, Do NOT code together

opioid dependence with intoxication (F11.22-)

Commonly Confused Codes

•F11.13 — Opioid abuse with withdrawal: use when abuse (not dependence) is the documented pattern
•F11.93 — Opioid use, unspecified with withdrawal: use when the use pattern is unspecified
•F11.20 — Opioid dependence, uncomplicated: use when no active withdrawal is present
•F11.220 — Opioid dependence with intoxication: withdrawal and intoxication are mutually exclusive states