F11.29
BillableOpioid dependence with unspecified opioid-induced disorder
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F11.29 an HCC code?
Yes. F11.29 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 F11.29
For F11.29 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 F11.29 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F11.29 is the ICD-10-CM diagnosis code for opioid dependence with unspecified opioid-induced disorder. A person is dependent on opioids (such as heroin, prescription painkillers, or other opioid drugs) and has developed some kind of health problem caused by the opioid use, but the specific problem has not been identified or documented. This code is used when the opioid-related condition exists but is not clearly specified. F11.29 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, F11.29 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, F11.29 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.
Use this code only when an opioid-induced disorder is present but the specific type (such as opioid-induced depression, anxiety, or sleep disorder) cannot be determined from the medical record; if the specific disorder is documented, use a more specific F11.2x code instead. Because F11.29 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 F11.29 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use this code only when an opioid-induced disorder is present but the specific type (such as opioid-induced depression, anxiety, or sleep disorder) cannot be determined from the medical record; if the specific disorder is documented, use a more specific F11.2x code instead
- •Ensure opioid dependence is clearly documented in the patient's record; this code requires evidence of both dependence and an unspecified opioid-induced condition, so review clinical notes for both components before coding
Clinical Significance
Opioid dependence with unspecified opioid-induced disorder is the least specific code for dependence with an induced condition. It indicates that an opioid-related health problem exists beyond the dependence itself, but the specific disorder is not identified. This code should trigger documentation improvement efforts and provider queries.
Documentation Requirements
- ✓Provider documentation of opioid dependence
- ✓Documentation that an opioid-induced disorder exists but is not further specified
- ✓Evidence supporting the presence of an induced condition (symptoms, clinical findings)
- ✓Assessment of the patient's overall clinical picture