What is ICD-10 code F11.281?

F11.281 is the ICD-10-CM diagnosis code for Opioid dependence with opioid-induced sexual dysfunction. A person is dependent on opioids and has sexual dysfunction (difficulty with sexual arousal, performance, or satisfaction) caused by the opioid use. F11.281 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. F11.281 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. F11.281 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. F11.281 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 F11.281 map to under V28?

F11.281 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.

What documentation supports F11.281?

Document the specific type of sexual dysfunction if possible (erectile dysfunction, decreased libido, anorgasmia, etc.) This is a common side effect of chronic opioid use that should be addressed in treatment planning Because F11.281 maps to an HCC category, the documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) before the diagnosis is used for risk adjustment. See the MEAT criteria checklist at /meat-criteria for what Monitor, Evaluate, Assess, or Treat looks like in a note. MEAT is generic documentation evidence, not a payer-specific rule.

2026 ICD-10-CM F11.281: Opioid dependence

F11.281 maps to CMS-HCC V28 137. A source-labeled RAF reference is available. Documentation must support MEAT. MEAT criteria · RAF Calculator · HCC Buddy coding tools

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Code lookupF11.281Effective 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)

F11.281

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

Opioid dependence with opioid-induced sexual dysfunction

A person is dependent on opioids and has sexual dysfunction (difficulty with sexual arousal, performance, or satisfaction) caused by the opioid use.

Buddy Insight

Opioid dependence with opioid-induced sexual dysfunction reflects a well-documented pharmacological effect where chronic opioid use suppresses the hypothalamic-pituitary-gonadal axis, leading to hypogonadism, decreased testosterone, and resultant sexual dysfunction.

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

F11.2Opioid dependence

F11.28Opioid dependence with other opioid-induced disorder

F11.281Opioid dependence with opioid-induced sexual dysfunction

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for F11.281 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for F11.281 in this effective period.

Related Child Codes

Official

F11.282Opioid dependence with opioid-induced sleep disorder

F11.288Opioid dependence with other opioid-induced disorder

Includes

Official

ICD-10-CM does not list Includes notes for F11.281 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for F11.281 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for F11.281 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for F11.281 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for F11.281 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Provider documentation of opioid dependence

Documentation of specific sexual dysfunction (erectile dysfunction, decreased libido, anorgasmia, delayed ejaculation)

Statement attributing sexual dysfunction to opioid dependence

Hormone levels if tested (testosterone, luteinizing hormone, follicle-stimulating hormone)

MEAT Support

HCC Buddy guidance

Provider documentation of opioid dependence

Documentation of specific sexual dysfunction (erectile dysfunction, decreased libido, anorgasmia, delayed ejaculation)

Statement attributing sexual dysfunction to opioid dependence

Hormone levels if tested (testosterone, luteinizing hormone, follicle-stimulating hormone)

Audit Caution

HCC Buddy guidance

Not recognizing the well-established causal relationship between opioids and sexual dysfunction

Using a non-substance-related sexual dysfunction code when opioid dependence is documented as the cause

Using the abuse code when dependence is the established pattern

Not capturing this diagnosis when it is present because it seems secondary to other problems

Common Mistakes

HCC Buddy guidance

F11.181 — Opioid abuse with opioid-induced sexual dysfunction: use when abuse (not dependence) is documented

N52.9 — Male erectile dysfunction, unspecified: use when erectile dysfunction is NOT opioid-related

F52.0 — Hypoactive sexual desire disorder: use when decreased desire is NOT substance-induced

E29.1 — Testicular hypofunction: may be coded additionally if opioid-induced hypogonadism is documented

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 F11.281 an HCC code?

Yes. F11.281 (Opioid dependence with opioid-induced sexual dysfunction) 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: F11.281 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: F11.281
Description: Opioid dependence with opioid-induced sexual dysfunction
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 F11.281 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT Criteria for F11.281

For F11.281 to 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 F11.281 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

F11.281 is the ICD-10-CM diagnosis code for opioid dependence with opioid-induced sexual dysfunction. A person is dependent on opioids and has sexual dysfunction (difficulty with sexual arousal, performance, or satisfaction) caused by the opioid use. F11.281 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, F11.281 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 F11.281; use the applicable model and payment year when reviewing the V28 mapping. 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. 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.

Document the specific type of sexual dysfunction if possible (erectile dysfunction, decreased libido, anorgasmia, etc.). Because F11.281 maps to an HCC category, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) before the diagnosis is used for risk adjustment. 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 F11.281 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Document the specific type of sexual dysfunction if possible (erectile dysfunction, decreased libido, anorgasmia, etc.)
•This is a common side effect of chronic opioid use that should be addressed in treatment planning

Clinical Significance

Documentation Requirements

✓Provider documentation of opioid dependence
✓Documentation of specific sexual dysfunction (erectile dysfunction, decreased libido, anorgasmia, delayed ejaculation)
✓Statement attributing sexual dysfunction to opioid dependence
✓Hormone levels if tested (testosterone, luteinizing hormone, follicle-stimulating hormone)
✓Assessment ruling out other causes (vascular disease, diabetes, other medications)
✓Treatment plan addressing both dependence and sexual dysfunction

Commonly Confused Codes

•F11.181: Opioid abuse with opioid-induced sexual dysfunction: use when abuse (not dependence) is documented
•N52.9: Male erectile dysfunction, unspecified: use when erectile dysfunction is NOT opioid-related
•F52.0: Hypoactive sexual desire disorder: use when decreased desire is NOT substance-induced
•E29.1: Testicular hypofunction: may be coded additionally if opioid-induced hypogonadism is documented