F11.281
BillableOpioid dependence with opioid-induced sexual dysfunction
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F11.281 an HCC code?
Yes. F11.281 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
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 F11.281
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.
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/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, F11.281 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.
Document the specific type of sexual dysfunction if possible (erectile dysfunction, decreased libido, anorgasmia, etc.). Because F11.281 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 F11.281 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
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. This affects treatment adherence and quality of life and may require hormonal assessment and intervention.
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