F11.94 — Opioid use, unspecified with opioid-induced mood disorder

Risk adjustment

F11.94 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

F11.94 is named in 16 Medicare coverage policies — 15 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
• A56614Billing and Coding: Psychiatric Inpatient Hospitalization
• A56645Billing and Coding: Controlled Substance Monitoring and Drugs of Abuse Testing
• A56685Billing and Coding: Partial Hospitalization Programs