F11.988
BillableOpioid use, unspecified with other opioid-induced disorder
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F11.988 an HCC code?
Yes. F11.988 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 F11.988
For F11.988 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 F11.988 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F11.988 is the ICD-10-CM diagnosis code for opioid use, unspecified with other opioid-induced disorder. This code describes a patient who uses opioids (such as heroin, prescription painkillers, or other opioid substances) in an unspecified pattern and has developed a medical condition caused by the opioid use that is not classified elsewhere. Examples include opioid-induced sleep disorders or other complications from opioid use. F11.988 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, F11.988 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, F11.988 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 the specific pattern of opioid use (occasional, continuous, or in remission) cannot be determined from the medical record. Because F11.988 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 F11.988 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 the specific pattern of opioid use (occasional, continuous, or in remission) cannot be determined from the medical record
- •The 'other opioid-induced disorder' portion indicates a complication from opioid use; if a more specific opioid-related condition is documented (such as opioid-induced depression or anxiety), use the more specific code instead
Clinical Significance
This code captures other specified opioid-induced disorders that do not fit into the more specific categories like psychosis, sexual dysfunction, or sleep disorder. Examples include opioid-induced hyperalgesia, opioid-induced constipation of clinical significance, or opioid-induced endocrinopathy. Documenting these conditions demonstrates the full clinical complexity of opioid use and supports appropriate risk adjustment.
Documentation Requirements
- ✓Documentation of opioid use (substance and pattern if known)
- ✓Specific description of the opioid-induced disorder (not psychosis, sexual dysfunction, or sleep disorder)
- ✓Causal relationship statement linking the disorder to opioid use
- ✓Clinical findings supporting the induced disorder diagnosis
- ✓Exclusion of other potential causes for the induced disorder