F11.19 — Opioid abuse with unspecified opioid-induced disorder
F11.19 is a billable, specific ICD-10-CM code for opioid abuse with unspecified opioid-induced disorder. It is valid for submission on a claim.
Risk adjustment
F11.19 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:
- HCC 137 Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications0.424 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
F11.19 is named in 11 Medicare coverage policies — 10 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
- A56645Billing and Coding: Controlled Substance Monitoring and Drugs of Abuse Testing
- A56756Billing and Coding: Home Health - Psychiatric Care
- A56818Billing and Coding: Urine Drug Testing
How F11.19 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 F11.19.
- Abuse›drug NEC›opioid›with›unspecified disorder
Related codes at this level
Codes that share F11.1. If F11.19 is not quite right, the correct code is usually one of these.
Questions about F11.19
- Is F11.19 a billable ICD-10-CM code?
- Yes. F11.19 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does F11.19 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).