F11.21: Opioid dependence, in remission
F11.21, opioid dependence, in remission, is listed as a covered diagnosis in 9 Medicare billing and coding articles that apply to 37 HCPCS Level II codes, including G2067 (Medication assisted treatment, methadone; weekly bundle…), G2078 (Take-home supply of methadone; up to 7 additional day…), G2077 (Periodic assessment; assessing periodically by an otp…). The articles come from 5 Medicare contractors. A listed diagnosis supports medical necessity only; coverage still depends on the LCD's criteria and on documentation in the medical record.
HCPCS Level II codes with F11.21 as a covered diagnosis
| Code | Description | Medicare coverage | DMEPOS fee 2026 (state range) | Articles listing it |
|---|---|---|---|---|
| G2067 | Medication assisted treatment, methadone; weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing, if performed (provision of the services by a medicare-enrolled opioid treatment program) | Carrier judgment | — | 1 |
| G2078 | Take-home supply of methadone; up to 7 additional day supply (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure | Carrier judgment | — | 1 |
| G2077 | Periodic assessment; assessing periodically by an otp practitioner and includes a review of moud dosing, treatment response, other substance use disorder treatment needs, responses and patient-identified goals, and other relevant physical, nutrition and psychiatric treatment needs and goals; may be informed by administration of a standardized, evidence-based assessment, or the need and interest for harm reduction interventions and recovery support services (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to each primary code | Carrier judgment | — | 1 |
| G2074 | Medication assisted treatment, weekly bundle not including the drug, including substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a medicare-enrolled opioid treatment program) | Carrier judgment | — | 1 |
| G2068 | Medication assisted treatment, buprenorphine (oral); weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a medicare-enrolled opioid treatment program) | Carrier judgment | — | 1 |
| G2079 | Take-home supply of buprenorphine (oral); up to 7 additional day supply (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure | Carrier judgment | — | 1 |
| G2076 | Intake activities, including initial medical examination that is conducted by an appropriately licensed practitioner and preparation of a care plan, which may be informed by administration of a standardized, evidence-based assessment, and that includes the patient's goals and mutually agreed-upon actions for the patient to meet those goals, including harm reduction interventions; the patient's needs and goals in the areas of education, vocational training, and employment; and the medical and psychiatric, psychosocial, economic, legal, housing, physical activity and/or nutrition needs and other recovery support services that a patient needs and wishes to pursue, conducted by an appropriately licensed/credentialed personnel (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to each primary code | Carrier judgment | — | 1 |
| G2080 | Each additional 30 minutes of counseling in a week of medication assisted treatment, (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure | Carrier judgment | — | 1 |
| G1028 | Take-home supply of nasal naloxone; 2-pack of 8mg per 0.1 ml nasal spray (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure | Carrier judgment | — | 1 |
| G2215 | Take-home supply of nasal naloxone; 2-pack of 4mg per 0.1 ml nasal spray (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure | Carrier judgment | — | 1 |
| G2073 | Medication assisted treatment, naltrexone; weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a medicare-enrolled opioid treatment program) | Carrier judgment | — | 1 |
| G2069 | Medication assisted treatment, buprenorphine (injectable) administered on a monthly basis; bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a medicare-enrolled opioid treatment program) | Carrier judgment | — | 1 |
| G0137 | Intensive outpatient services; weekly bundle, minimum of 9 services over a 7 contiguous day period, which can include individual and group therapy with physicians or psychologists (or other mental health professionals to the extent authorized under state law); occupational therapy requiring the skills of a qualified occupational therapist; services of social workers, trained psychiatric nurses, and other staff trained to work with psychiatric patients; individualized activity therapies that are not primarily recreational or diversionary; family counseling (the primary purpose of which is treatment of the individual's condition); patient training and education (to the extent that training and educational activities are closely and clearly related to individual's care and treatment); diagnostic services; and such other items and services (excluding meals and transportation) that are reasonable and necessary for the diagnosis or active treatment of the individual's condition, reasonably expected to improve or maintain the individual's condition and functional level and to prevent relapse or hospitalization, and furnished pursuant to such guidelines relating to frequency and duration of services in accordance with a physician certification and plan of treatment (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure | Carrier judgment | — | 1 |
| G0532 | Take-home supply of nasal nalmefene hydrochloride; one carton of two, 2.7 mg per 0.1 ml nasal sprays (provision of the services by a medicare-enrolled opioid treatment program);( list separately in addition to each primary code) | Carrier judgment | — | 1 |
| G0533 | Medication assisted treatment, buprenorphine (injectable) administered on a weekly basis; weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a medicare-enrolled opioid treatment program) | Carrier judgment | — | 1 |
| G0534 | Coordinated care and/or referral services, such as to adequate and accessible community resources to address unmet health-related social needs, including harm reduction interventions and recovery support services a patient needs and wishes to pursue, which significantly limit the ability to diagnose or treat an opioid use disorder; each additional 30 minutes of services (provision of the services by a medicare-enrolled opioid treatment program); (list separately in addition to each primary code) | Carrier judgment | — | 1 |
| G0535 | Patient navigational services, provided directly or by referral; including helping the patient to navigate health systems and identify care providers and supportive services, to build patient self-advocacy and communication skills with care providers, and to promote patient-driven action plans and goals; each additional 30 minutes of services (provision of the services by a medicare-enrolled opioid treatment program); (list separately in addition to each primary code) | Carrier judgment | — | 1 |
| G0536 | Peer recovery support services, provided directly or by referral; including leveraging knowledge of the condition or lived experience to provide support, mentorship, or inspiration to meet oud treatment and recovery goals; conducting a person-centered interview to understand the patient's life story, strengths, needs, goals, preferences, and desired outcomes; developing and proposing strategies to help meet person-centered treatment goals; assisting the patient in locating or navigating recovery support services; each additional 30 minutes of services (provision of the services by a medicare-enrolled opioid treatment program); (list separately in addition to each primary code) | Carrier judgment | — | 1 |
| G2075 | Medication assisted treatment, medication not otherwise specified; weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing, if performed (provision of the services by a medicare-enrolled opioid treatment program) | Carrier judgment | — | 1 |
| G2216 | Take-home supply of injectable naloxone (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure | Carrier judgment | — | 1 |
| G0017 | Psychotherapy for crisis furnished in an applicable site of service (any place of service at which the non-facility rate for psychotherapy for crisis services applies, other than the office setting); first 60 minutes | Carrier judgment | — | 4 |
| G0018 | Psychotherapy for crisis furnished in an applicable site of service (any place of service at which the non-facility rate for psychotherapy for crisis services applies, other than the office setting); each additional 30 minutes (list separately in addition to code for primary service) | Carrier judgment | — | 4 |
| G0410 | Group psychotherapy other than of a multiple-family group, in a partial hospitalization or intensive outpatient setting, approximately 45 to 50 minutes | Carrier judgment | — | 3 |
| G0411 | Interactive group psychotherapy, in a partial hospitalization or intensive outpatient setting, approximately 45 to 50 minutes | Carrier judgment | — | 3 |
| G0560 | Safety planning interventions, each 20 minutes personally performed by the billing practitioner, including assisting the patient in the identification of the following personalized elements of a safety plan: recognizing warning signs of an impending suicidal or substance use-related crisis; employing internal coping strategies; utilizing social contacts and social settings as a means of distraction from suicidal thoughts or risky substance use; utilizing family members, significant others, caregivers, and/or friends to help resolve the crisis; contacting mental health or substance use disorder professionals or agencies; and making the environment safe | Carrier judgment | — | 2 |
12 more codes are listed. See every code with payment by region in Caduvo.
Medicare policy articles listing F11.21
- A59718: Billing and Coding: Opioid Treatment Programs (Palmetto GBA (MAC - Part A, MAC - Part B); 20 Level II codes). LCD with the same title: L39849
- A57053: Billing and Coding: Psychiatric Partial Hospitalization Programs (CGS Administrators, LLC (MAC - Part A, MAC - Part B); 5 Level II codes). LCD with the same title: L33626, L34196
- A59723: Billing and Coding: Outpatient Psychotherapy (Palmetto GBA (MAC - Part A, MAC - Part B); 7 Level II codes). LCD with the same title: L39853
- A57520: Billing and Coding: Psychiatric Diagnostic Evaluation and Psychotherapy Services (First Coast Service Options, Inc. (MAC - Part A, MAC - Part B); 3 Level II codes). LCD with the same title: L33252
- A57480: Billing and Coding: Psychiatry and Psychology Services (WPS Insurance Corporation (MAC - Part A, MAC - Part B); 4 Level II codes). LCD with the same title: L33632, L34616
- A56818: Billing and Coding: Urine Drug Testing (CGS Administrators, LLC (MAC - Part A, MAC - Part B); 5 Level II codes). LCD with the same title: L34645, L35724, L36029, L36668
- A56645: Billing and Coding: Controlled Substance Monitoring and Drugs of Abuse Testing (Novitas Solutions, Inc. (MAC - Part A, MAC - Part B); 5 Level II codes). LCD with the same title: L35006, L36393
- A57130: Billing and Coding: Psychiatric Codes (Novitas Solutions, Inc. (MAC - Part A, MAC - Part B); 4 Level II codes). LCD with the same title: L35101
- A57780: Billing and Coding: Psychological and Neuropsychological Tests (First Coast Service Options, Inc. (MAC - Part A, MAC - Part B); 1 Level II codes). LCD with the same title: L34520
A diagnosis listed as covered in a billing and coding article supports medical necessity for the article's codes; it does not guarantee payment. Coverage depends on the LCD's criteria, the contractor's jurisdiction and documentation in the medical record.
Other F11 diagnoses (Opioid related disorders)
- F11.20 — Opioid dependence, uncomplicated
- F11.220 — Opioid dependence with intoxication, uncomplicated
- F11.221 — Opioid dependence with intoxication delirium
- F11.222 — Opioid dependence with intoxication with perceptual disturbance
- F11.229 — Opioid dependence with intoxication, unspecified
- F11.23 — Opioid dependence with withdrawal
- F11.24 — Opioid dependence with opioid-induced mood disorder
- F11.250 — Opioid dependence with opioid-induced psychotic disorder with…
- F11.251 — Opioid dependence with opioid-induced psychotic disorder with…
- F11.259 — Opioid dependence with opioid-induced psychotic disorder, unspecified
- F11.281 — Opioid dependence with opioid-induced sexual dysfunction
- F11.282 — Opioid dependence with opioid-induced sleep disorder
- F11.288 — Opioid dependence with other opioid-induced disorder
- F11.29 — Opioid dependence with unspecified opioid-induced disorder
- F11.10 — Opioid abuse, uncomplicated
- F11.11 — Opioid abuse, in remission
- F11.120 — Opioid abuse with intoxication, uncomplicated
- F11.121 — Opioid abuse with intoxication delirium
- F11.122 — Opioid abuse with intoxication with perceptual disturbance
- F11.129 — Opioid abuse with intoxication, unspecified
- F11.13 — Opioid abuse with withdrawal
- F11.14 — Opioid abuse with opioid-induced mood disorder
- F11.150 — Opioid abuse with opioid-induced psychotic disorder with delusions
- F11.151 — Opioid abuse with opioid-induced psychotic disorder with…
- F11.159 — Opioid abuse with opioid-induced psychotic disorder, unspecified
- F11.181 — Opioid abuse with opioid-induced sexual dysfunction
- F11.182 — Opioid abuse with opioid-induced sleep disorder
- F11.188 — Opioid abuse with other opioid-induced disorder
- F11.19 — Opioid abuse with unspecified opioid-induced disorder
- F11.90 — Opioid use, unspecified, uncomplicated
Frequently asked questions
Does Medicare cover F11.21 (Opioid dependence, in remission)?
Medicare covers items and services, not diagnoses. 9 Medicare billing and coding articles list F11.21 as a covered diagnosis for 37 HCPCS Level II codes: the diagnosis can support medical necessity for those codes, but payment still depends on the LCD's coverage criteria and the medical record.
Which HCPCS codes can be billed with ICD-10 F11.21?
The Level II codes from the policies most specific to this diagnosis are G2067 (Medication assisted treatment, methadone; weekly bundle…, 1 article); G2078 (Take-home supply of methadone; up to 7 additional day…, 1 article); G2077 (Periodic assessment; assessing periodically by an otp…, 1 article); G2074 (Medication assisted treatment, weekly bundle not including…, 1 article); G2068 (Medication assisted treatment, buprenorphine (oral)…, 1 article). Code choice depends on the item supplied; check each code's descriptor.
Which Medicare policy articles list F11.21?
A59718 (Billing and Coding: Opioid Treatment Programs); A57053 (Billing and Coding: Psychiatric Partial Hospitalization Programs); A59723 (Billing and Coding: Outpatient Psychotherapy), and 6 more articles.
What is ICD-10-CM code F11.21?
F11.21 is the ICD-10-CM code for opioid dependence, in remission, in category F11 (Opioid related disorders), chapter 5: Mental, behavioral and neurodevelopmental disorders.
Next steps
- Run a reimbursement report for a device billed under G2067
- Watch G2067 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for G2067
Sources: CMS Medicare Coverage Database billing and coding articles (covered ICD-10 code lists and HCPCS links); ICD-10-CM FY2026; CMS HCPCS Level II release October 2026; CMS DMEPOS fee schedule 2026 (non-rural state fees). Not billing or legal advice.
Chapter 5: Mental, behavioral and neurodevelopmental disorders · All diagnoses · HCPCS lookup