ICD-10 · PDGM grouping
F11 Opioid related disorders
All 45 codes in the F11 family, with the PDGM clinical group, comorbidity subgroup and primary-position rule CMS assigns, read from the CMS grouper crosswalk v07.2.26 and the CDC FY2027 code file.
ICD-10-CM FY2027 · CMS grouper v07.2.26
Codes in family
45
Can lead a claim
43
Cannot lead a claim
2
What CMS assigns to F11
43 of the 45 codes group to Behavioral Health; 2 are assigned no clinical group. 2 of the 45 count toward the Mental and Behavioral Disorders Due to Psychoactive Substance Abuse comorbidity subgroup; 43 are assigned none. 43 of the 45 can lead a claim.
- Mental and Behavioral Disorders Due to Psychoactive Substance Abuse
Every code in F11
Descriptions are CDC’s FY2027 wording; where CMS’s grouper abbreviates one, its form is shown beneath.
| Code | Description | Primary position | Clinical group | Comorbidity subgroup |
|---|---|---|---|---|
| F11.1 Opioid abuse | ||||
| F11.10 | Opioid abuse, uncomplicated | Can lead a claim | F | None |
| F11.11 | Opioid abuse, in remission | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| F11.12 Opioid abuse with intoxication | ||||
| F11.120 | Opioid abuse with intoxication, uncomplicated | Can lead a claim | F | None |
| F11.121 | Opioid abuse with intoxication delirium | Can lead a claim | F | None |
| F11.122 | Opioid abuse with intoxication with perceptual disturbance | Can lead a claim | F | None |
| F11.129 | Opioid abuse with intoxication, unspecified | Can lead a claim | F | None |
| F11.13 | Opioid abuse with withdrawal | Can lead a claim | F | Mental and Behavioral Disorders Due to Psychoactive Substance Abuse |
| F11.14 | Opioid abuse with opioid-induced mood disorder | Can lead a claim | F | None |
| F11.15 Opioid abuse with opioid-induced psychotic disorder | ||||
| F11.150 | Opioid abuse with opioid-induced psychotic disorder with delusionsCMS: Opioid abuse w opioid-induced psychotic disorder w delusions | Can lead a claim | F | None |
| F11.151 | Opioid abuse with opioid-induced psychotic disorder with hallucinationsCMS: Opioid abuse w opioid-induced psychotic disorder w hallucin | Can lead a claim | F | None |
| F11.159 | Opioid abuse with opioid-induced psychotic disorder, unspecifiedCMS: Opioid abuse with opioid-induced psychotic disorder, unsp | Can lead a claim | F | None |
| F11.18 Opioid abuse with other opioid-induced disorder | ||||
| F11.181 | Opioid abuse with opioid-induced sexual dysfunction | Can lead a claim | F | None |
| F11.182 | Opioid abuse with opioid-induced sleep disorder | Can lead a claim | F | None |
| F11.188 | Opioid abuse with other opioid-induced disorder | Can lead a claim | F | None |
| F11.19 | Opioid abuse with unspecified opioid-induced disorder | Can lead a claim | F | None |
| F11.2 Opioid dependence | ||||
| F11.20 | Opioid dependence, uncomplicated | Can lead a claim | F | Mental and Behavioral Disorders Due to Psychoactive Substance Abuse |
| F11.21 | Opioid dependence, in remission | Can lead a claim | F | None |
| F11.22 Opioid dependence with intoxication | ||||
| F11.220 | Opioid dependence with intoxication, uncomplicated | Can lead a claim | F | None |
| F11.221 | Opioid dependence with intoxication delirium | Can lead a claim | F | None |
| F11.222 | Opioid dependence with intoxication with perceptual disturbanceCMS: Opioid dependence w intoxication with perceptual disturbance | Can lead a claim | F | None |
| F11.229 | Opioid dependence with intoxication, unspecified | Can lead a claim | F | None |
| F11.23 | Opioid dependence with withdrawal | Can lead a claim | F | None |
| F11.24 | Opioid dependence with opioid-induced mood disorder | Can lead a claim | F | None |
| F11.25 Opioid dependence with opioid-induced psychotic disorder | ||||
| F11.250 | Opioid dependence with opioid-induced psychotic disorder with delusionsCMS: Opioid depend w opioid-induc psychotic disorder w delusions | Can lead a claim | F | None |
| F11.251 | Opioid dependence with opioid-induced psychotic disorder with hallucinationsCMS: Opioid depend w opioid-induc psychotic disorder w hallucin | Can lead a claim | F | None |
| F11.259 | Opioid dependence with opioid-induced psychotic disorder, unspecifiedCMS: Opioid dependence w opioid-induced psychotic disorder, unsp | Can lead a claim | F | None |
| F11.28 Opioid dependence with other opioid-induced disorder | ||||
| F11.281 | Opioid dependence with opioid-induced sexual dysfunction | Can lead a claim | F | None |
| F11.282 | Opioid dependence with opioid-induced sleep disorder | Can lead a claim | F | None |
| F11.288 | Opioid dependence with other opioid-induced disorder | Can lead a claim | F | None |
| F11.29 | Opioid dependence with unspecified opioid-induced disorder | Can lead a claim | F | None |
| F11.9 Opioid use, unspecified | ||||
| F11.90 | Opioid use, unspecified, uncomplicated | Can lead a claim | F | None |
| F11.91 | Opioid use, unspecified, in remission | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| F11.92 Opioid use, unspecified with intoxication | ||||
| F11.920 | Opioid use, unspecified with intoxication, uncomplicated | Can lead a claim | F | None |
| F11.921 | Opioid use, unspecified with intoxication delirium | Can lead a claim | F | None |
| F11.922 | Opioid use, unspecified with intoxication with perceptual disturbanceCMS: Opioid use, unsp w intoxication with perceptual disturbance | Can lead a claim | F | None |
| F11.929 | Opioid use, unspecified with intoxication, unspecified | Can lead a claim | F | None |
| F11.93 | Opioid use, unspecified with withdrawal | Can lead a claim | F | None |
| F11.94 | Opioid use, unspecified with opioid-induced mood disorder | Can lead a claim | F | None |
| F11.95 Opioid use, unspecified with opioid-induced psychotic disorder | ||||
| F11.950 | Opioid use, unspecified with opioid-induced psychotic disorder with delusionsCMS: Opioid use, unsp w opioid-induc psych disorder w delusions | Can lead a claim | F | None |
| F11.951 | Opioid use, unspecified with opioid-induced psychotic disorder with hallucinationsCMS: Opioid use, unsp w opioid-induc psych disorder w hallucin | Can lead a claim | F | None |
| F11.959 | Opioid use, unspecified with opioid-induced psychotic disorder, unspecifiedCMS: Opioid use, unsp w opioid-induced psychotic disorder, unsp | Can lead a claim | F | None |
| F11.98 Opioid use, unspecified with other specified opioid-induced disorder | ||||
| F11.981 | Opioid use, unspecified with opioid-induced sexual dysfunctionCMS: Opioid use, unsp with opioid-induced sexual dysfunction | Can lead a claim | F | None |
| F11.982 | Opioid use, unspecified with opioid-induced sleep disorder | Can lead a claim | F | None |
| F11.988 | Opioid use, unspecified with other opioid-induced disorder | Can lead a claim | F | None |
| F11.99 | Opioid use, unspecified with unspecified opioid-induced disorderCMS: Opioid use, unsp with unspecified opioid-induced disorder | Can lead a claim | F | None |
Sources: CMS HH PPS Grouper Software v07.2.26, effective 2026-10-01, for the clinical group, comorbidity subgroup, code-first conventions and primary-position flags; CDC NCHS ICD-10-CM FY2027 code descriptions for the family title and code wording. This is the crosswalk Medicare runs a claim through. Grouping also depends on admission source, timing, the OASIS functional items and the rest of the diagnosis list.
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