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. Look up the whole chart to see which of its HCCs the hierarchy would zero.

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 one applies depends on your Medicare contractor.

• 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