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ICD-10-CM F11.20: Opioid dependence, uncomplicated

F11.20 is the billable ICD-10-CM code for opioid dependence, uncomplicated, in category F11 (Opioid related disorders) of the Mental and behavioral disorders due to psychoactive substance use section. As a principal diagnosis it groups to MS-DRG 894 Alcohol, Drug Abuse or Dependence, Left AMA, MS-DRG 895 Alcohol, Drug Abuse or Dependence with Rehabilitation Therapy, MS-DRG 896 Alcohol, Drug Abuse or Dependence without Rehabilitation Therapy with MCC (MDC 20 MDC 20: Alcohol or Drug Use or Induced Organic Mental Disorders). It maps to HCC 137 (Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications) in CMS-HCC V28. As a secondary diagnosis it is a CC, excluded with 1 principal diagnoses. 21 LCD billing and coding articles list it as covered.

Compiled from CMS files by the QuickIntell RCM Editorial Team · Data effective · Method: reference methodology · Report a data correction

Data currency: ICD-10-CM code descriptions: FY2027 (effective October 1, 2026); IPPS Table 5 (MS-DRG weights): v44 FY2027 (final rule + CN3) (effective October 1, 2026); ICD-10-CM to HCC mapping: PY2027 initial ICD-10-CM mappings (dates of service 2026) (payment year 2027); Medicare Coverage Database billing and coding articles: MCD release October 8, 2026 (effective October 4, 2026). Next CMS release: FY2028 code files, effective October 1, 2027 for the ICD-10-CM code descriptions; FY2028 final rule (August 2027), effective October 1, 2027; an April 1 interim grouper update when CMS issues one for the IPPS Table 5 (MS-DRG weights); PY2028 advance notice (February 2027) and the PY2027 midyear final mapping (spring 2027) for the ICD-10-CM to HCC mapping; weekly, every Thursday for the Medicare Coverage Database billing and coding articles.

Code
F11.20
billable FY2027 ICD-10-CM code
Category
F11 Opioid related disorders
Chapter
5: Mental, Behavioral and Neurodevelopmental disorders (F01-F99)
CC/MCC (MS-DRG v44)
CC
CMS-HCC V28
HCC 137
POA reporting
Required

Tabular list notes for F11.20

Inclusion terms
  • Opioid use disorder, moderate
  • Opioid use disorder, severe

Inherited from F11.2 (Opioid dependence)

Excludes1 (never coded together)
  • opioid abuse (F11.1-)
  • opioid use, unspecified (F11.9-)
Excludes2 (not part of this condition, may be coded together)
  • opioid poisoning (T40.0-T40.2-)

MS-DRG grouping when F11.20 is the principal diagnosis

MS-DRG v44 groups for F11.20 as principal diagnosis
MDCMS-DRGs
20 MDC 20: Alcohol or Drug Use or Induced Organic Mental Disorders894895896897

The final group also depends on procedures, secondary diagnoses and discharge status; the MS-DRG lookup for F11.20 shows the full grouping logic.

CC/MCC status and inpatient edits

As a secondary diagnosis, F11.20 is a CC under MS-DRG v44, unless the principal diagnosis is one of the 1 codes in its exclusion list. Check F11.20 against a principal diagnosis.

  • Present on admission: a POA indicator is required on inpatient claims.

CMS-HCC V28 risk adjustment

In the PY2027 mapping, F11.20 maps to HCC 137 (Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications). The HCC lookup shows the RAF weight and the hierarchy.

LCD billing and coding articles that list F11.20

21 current Medicare billing and coding articles list F11.20 among the diagnoses that support medical necessity for the services they cover.

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Frequently asked questions

What does ICD-10-CM F11.20 mean?

F11.20 means opioid dependence, uncomplicated. The tabular list also files these terms under it: Opioid use disorder, moderate; Opioid use disorder, severe. It is one of 25 billable codes under F11, opioid related disorders.

What can't be coded with F11.20?

Excludes1 at F11.2: opioid abuse (F11.1-); opioid use, unspecified (F11.9-). These are never reported together with F11.20.

Which MS-DRG does F11.20 group to?

As the principal diagnosis, F11.20 groups to MS-DRG 894 Alcohol, Drug Abuse or Dependence, Left AMA, MS-DRG 895 Alcohol, Drug Abuse or Dependence with Rehabilitation Therapy, MS-DRG 896 Alcohol, Drug Abuse or Dependence without Rehabilitation Therapy with MCC (MDC 20 MDC 20: Alcohol or Drug Use or Induced Organic Mental Disorders) under MS-DRG v44, before procedures and secondary diagnoses are applied.

Does F11.20 map to an HCC?

Yes: HCC 137, Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications, in the PY2027 CMS-HCC V28 mapping.

Is F11.20 a CC or MCC?

F11.20 is a CC under MS-DRG v44; 1 principal diagnoses exclude it.

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.

Disclaimer

The descriptor and notes are reproduced from the FY2027 ICD-10-CM files; MS-DRG, CC/MCC and HCC facts come from the CMS FY2027 and PY2027 tables. Code from the medical record and the ICD-10-CM Official Guidelines. Not legal, clinical or billing advice.

Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.