F11.11 — Opioid abuse, in remission
F11.11 is a billable, specific ICD-10-CM code for opioid abuse, in remission. It is valid for submission on a claim.
Inclusion terms
Alternative wordings a physician may use in the chart for this same code.
- Opioid use disorder, mild, in early remission
- Opioid use disorder, mild, in sustained remission
Risk adjustment
F11.11 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
F11.11 is named in 13 Medicare coverage policies — 12 listing it as supporting medical necessity, and 1 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
- A54799Billing and Coding: Urine Drug Testing
- A55001Billing and Coding: Urine Drug Testing
- A56645Billing and Coding: Controlled Substance Monitoring and Drugs of Abuse Testing
How F11.11 is indexed
Coders do not find codes by browsing the tabular list — they look them up in the alphabetic index, under the word the physician wrote. These are the index entries that lead here, so you can see which chart wordings map to F11.11.
- Abuse›drug NEC›opioid›in remission(early) (sustained)
- Disorder›opioid use›mild›in remission(early) (sustained)
Related codes at this level
Codes that share F11.1. If F11.11 is not quite right, the correct code is usually one of these.
- F11.10Opioid abuse, uncomplicated
- F11.12Opioid abuse with intoxication
- F11.13Opioid abuse with withdrawal
- F11.14Opioid abuse with opioid-induced mood disorder
- F11.15Opioid abuse with opioid-induced psychotic disorder
- F11.18Opioid abuse with other opioid-induced disorder
- F11.19Opioid abuse with unspecified opioid-induced disorder
Questions about F11.11
- Is F11.11 a billable ICD-10-CM code?
- Yes. F11.11 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does F11.11 sit in the tabular list?
- Mental, Behavioral and Neurodevelopmental disorders (F01-F99), in the block Mental and behavioral disorders due to psychoactive substance use (F10-F19).