F11.94
BillableOpioid use, unspecified with opioid-induced mood disorder
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F11.94 an HCC code?
Yes. F11.94 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 F11.94
For F11.94 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 F11.94 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F11.94 is the ICD-10-CM diagnosis code for opioid use, unspecified with opioid-induced mood disorder. Depression, anxiety, or other mood disturbances that are directly caused by opioid use rather than a separate mood disorder. F11.94 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, F11.94 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, F11.94 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 that the mood disorder is opioid-induced and not a pre-existing condition. Because F11.94 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 F11.94 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document that the mood disorder is opioid-induced and not a pre-existing condition
- •Specify the type of mood disorder if documented (depressive, anxiety, etc.)
Clinical Significance
Opioid use, unspecified with opioid-induced mood disorder captures mood disturbances directly caused by opioid use in a patient whose use pattern is not classified. Opioid-induced mood changes, particularly depression, are clinically important because they require treatment of the underlying opioid use rather than standard antidepressant therapy alone.
Documentation Requirements
- ✓Documentation of mood disorder symptoms (depression, mania, irritability, anhedonia)
- ✓Provider statement that the mood disorder is opioid-induced
- ✓Temporal relationship between opioid use and mood symptom onset
- ✓Assessment distinguishing from primary mood disorders
- ✓Documentation of opioid use (though pattern not classified)
- ✓Treatment plan addressing both opioid use and mood symptoms
Commonly Confused Codes
- •F11.14 — Opioid abuse with opioid-induced mood disorder: use when abuse is documented
- •F11.24 — Opioid dependence with opioid-induced mood disorder: use when dependence is documented
- •F32.9 — Major depressive disorder, single episode, unspecified: use when depression is NOT opioid-induced
- •F10.94 — Alcohol use, unspecified with alcohol-induced mood disorder: use when alcohol (not opioids) is the substance