F11.29 ICD-10-CM Code: Opioid dependence with unspecified opioid-induced disorder
F11.29 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 Buddy coding tools
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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)
F11.29
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceOpioid 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.
Buddy Insight
Opioid dependence with unspecified opioid-induced disorder is the least specific code for dependence with an induced condition.
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
OfficialNo inclusion terms are included in this display for F11.29. Check the code and parent instructions in the Code Book.
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 F11.29. Check the code and parent instructions in the Code Book.
Use Additional
OfficialNo Use Additional Code instructions are included in this display for F11.29. Check the code and parent instructions in the Code Book.
Code Also
OfficialNo Code Also instructions are included in this display for F11.29. 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 F11.29 an HCC code?
Yes. F11.29 (Opioid dependence with unspecified opioid-induced disorder) 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: F11.29 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
- F11.29
- Description
- Opioid dependence with unspecified opioid-induced disorder
- 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 F11.29 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for F11.29
For F11.29, 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
F11.29 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, 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 F11.29; 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.
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. For F11.29, 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 F11.29 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
Commonly Confused Codes
- •F11.20: Opioid dependence, uncomplicated: use when NO induced disorder is present at all
- •F11.288: Opioid dependence with other opioid-induced disorder: use when the disorder IS identified but lacks a specific code
- •F11.24: Opioid dependence with opioid-induced mood disorder: use when mood disorder is documented
- •F11.99: Opioid use, unspecified with unspecified opioid-induced disorder: use when the use pattern is also unspecified