F11.93 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 coding software

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Code lookupF11.93

Effective 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)

F11.93

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

Opioid use, unspecified with withdrawal

Physical and psychological symptoms that occur when someone stops using opioids after prolonged use, including anxiety, body aches, and cravings.

Buddy Insight

Opioid use, unspecified with withdrawal captures opioid withdrawal symptoms in a patient whose use pattern is not classified as abuse or dependence.

Overview Risk Models Code Book Documentation Audit Notes Edition comparison

CMS-HCC V28

Mapped

HCC 137

Drug Use Disorder, Moderate/S...

Coefficient HCC 137: 0.424 (Community Non-Dual Aged (CNA))

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

Inclusion Terms

Official

No inclusion terms are included in this display for F11.93. 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

Related Codes

Official

F11.90Opioid use, unspecified, uncomplicated F11.91Opioid use, unspecified, in remission F11.92Opioid use, unspecified with intoxication F11.94Opioid use, unspecified with opioid-induced mood disorder F11.95Opioid use, unspecified with opioid-induced psychotic disorder

Includes

Official

disorders of psychological developmentInherited from F01-F99

Excludes 1

Official

opioid use, unspecified with intoxication (F11.92-)
opioid abuse (F11.1-)Inherited from F11.9
opioid dependence (F11.2-)Inherited from F11.9

Code First

Official

No Code First sequencing instructions are included in this display for F11.93. Check the code and parent instructions in the Code Book.

Use Additional

Official

No Use Additional Code instructions are included in this display for F11.93. Check the code and parent instructions in the Code Book.

Code Also

Official

No Code Also instructions are included in this display for F11.93. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance

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

Statement that opioid use pattern is not specified

Clinical Opiate Withdrawal Scale (COWS) score if available

Temporal relationship between opioid reduction/cessation and symptoms

MEAT Support

HCC Buddy guidance

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

Statement that opioid use pattern is not specified

Clinical Opiate Withdrawal Scale (COWS) score if available

Temporal relationship between opioid reduction/cessation and symptoms

Audit Caution

HCC Buddy guidance

Using this code when documentation supports abuse or dependence classification

Confusing withdrawal symptoms with intoxication — they are opposite clinical presentations

Not recognizing 'flu-like symptoms' in an opioid user as potential withdrawal

Coding unspecified use with withdrawal when the presence of withdrawal itself suggests at least physiological dependence

Common Mistakes

HCC Buddy guidance

F11.13 — Opioid abuse with withdrawal: use when abuse is documented

F11.23 — Opioid dependence with withdrawal: use when dependence is documented

F11.920 — Opioid use, unspecified with intoxication: withdrawal and intoxication are clinically opposite

T40.2X1A — Poisoning by other opioids: poisoning codes are for overdose, not withdrawal

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 F11.93 an HCC code?

Yes. F11.93 (Opioid use, unspecified with withdrawal) 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: F11.93 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: F11.93
Description: Opioid use, unspecified with withdrawal
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 F11.93 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for F11.93

For F11.93, 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

F11.93 is the ICD-10-CM diagnosis code for opioid use, unspecified with withdrawal. Physical and psychological symptoms that occur when someone stops using opioids after prolonged use, including anxiety, body aches, and cravings. F11.93 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, F11.93 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. 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.

Document withdrawal symptoms such as sweating, tremors, insomnia, or muscle aches. For F11.93, 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 F11.93 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Document withdrawal symptoms such as sweating, tremors, insomnia, or muscle aches
•Distinguish from intoxication codes; withdrawal occurs during abstinence or reduction of opioid use

Clinical Significance

Opioid use, unspecified with withdrawal captures opioid withdrawal symptoms in a patient whose use pattern is not classified as abuse or dependence. Opioid withdrawal causes significant distress including muscle pain, gastrointestinal symptoms, anxiety, and insomnia. This code is used when documentation confirms withdrawal but does not specify the severity of the underlying use disorder.

Documentation Requirements

✓Documentation of opioid withdrawal symptoms (myalgia, rhinorrhea, lacrimation, diaphoresis, piloerection, nausea, diarrhea, insomnia, anxiety)
✓Statement that opioid use pattern is not specified
✓Clinical Opiate Withdrawal Scale (COWS) score if available
✓Temporal relationship between opioid reduction/cessation and symptoms
✓Treatment plan for withdrawal management

Excludes 1, Do NOT code together

opioid use, unspecified with intoxication (F11.92-)

Commonly Confused Codes

•F11.13: Opioid abuse with withdrawal: use when abuse is documented
•F11.23: Opioid dependence with withdrawal: use when dependence is documented
•F11.920: Opioid use, unspecified with intoxication: withdrawal and intoxication are clinically opposite
•T40.2X1A: Poisoning by other opioids: poisoning codes are for overdose, not withdrawal