F11.10 — Opioid abuse, uncomplicated

Risk adjustment

F11.10 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:

• HCC 138 Drug Use Disorder, Mild, Uncomplicated, Except Cannabis0.423 RAF

Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score.

Medicare coverage

F11.10 is named in 15 Medicare coverage policies — 13 listing it as supporting medical necessity, and 2 listing it as NOT covered. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.

• A52434Health and Behavior Assessment/Intervention – Medical Policy Articlenot covered
• A56865Billing and Coding: Psychiatric Inpatient Hospitalizationnot covered
• A56818Billing and Coding: Urine Drug Testing
• A56937Billing and Coding: Psychiatry and Psychology Services