F11.251: Opioid dependence with opioid-induced psychotic disorder with hallucinations
F11.251, opioid dependence with opioid-induced psychotic disorder with hallucinations, is listed as a covered diagnosis in 18 Medicare billing and coding articles that apply to 42 HCPCS Level II codes, including G0480 (Drug test(s), definitive, utilizing (1) drug…), G0483 (Drug test(s), definitive, utilizing (1) drug…), G0482 (Drug test(s), definitive, utilizing (1) drug…). The articles come from 7 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 F11.251 as a covered diagnosis
| Code | Description | Medicare coverage | DMEPOS fee 2026 (state range) | Articles listing it |
|---|---|---|---|---|
| G0480 | Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 1-7 drug class(es), including metabolite(s) if performed | Carrier judgment | — | 7 |
| G0483 | Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 22 or more drug class(es), including metabolite(s) if performed | Carrier judgment | — | 7 |
| G0482 | Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 15-21 drug class(es), including metabolite(s) if performed | Carrier judgment | — | 7 |
| G0481 | Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 8-14 drug class(es), including metabolite(s) if performed | Carrier judgment | — | 7 |
| G0659 | Drug test(s), definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem), excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase), performed without method or drug-specific calibration, without matrix-matched quality control material, or without use of stable isotope or other universally recognized internal standard(s) for each drug, drug metabolite or drug class per specimen; qualitative or quantitative, all sources, includes specimen validity testing, per day, any number of drug classes | Carrier judgment | — | 7 |
| 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 | — | 5 |
| G0411 | Interactive group psychotherapy, in a partial hospitalization or intensive outpatient setting, approximately 45 to 50 minutes | Carrier judgment | — | 5 |
| G0129 | Occupational therapy services requiring the skills of a qualified occupational therapist, furnished as a component of a partial hospitalization or intensive outpatient treatment program, per session (45 minutes or more) | Carrier judgment | — | 3 |
| G0176 | Activity therapy, such as music, dance, art or play therapies not for recreation, related to the care and treatment of patient's disabling mental health problems, per session (45 minutes or more) | Special coverage instructions apply | — | 3 |
| G0177 | Training and educational services related to the care and treatment of patient's disabling mental health problems per session (45 minutes or more) | Special coverage instructions apply | — | 3 |
| 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 |
17 more codes are listed. See every code with payment by region in Caduvo.
Medicare policy articles listing F11.251
- 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
- A56850: Billing and Coding: Psychiatric Partial Hospitalization Programs (Wellpoint Federal (MAC - Part A, MAC - Part B); 5 Level II codes). LCD with the same title: L33626, L34196
- A56685: Billing and Coding: Partial Hospitalization Programs (Palmetto GBA (MAC - Part A); 5 Level II codes). LCD with the same title: L37633
- A57077: Billing and Coding: Controlled Substance Monitoring and Drugs of Abuse Testing (First Coast Service Options, Inc. (MAC - Part A, MAC - Part B); 5 Level II codes). LCD with the same title: L35006, L36393
- 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
- A55001: Billing and Coding: Urine Drug Testing (Noridian Healthcare Solutions, LLC (MAC - Part A, MAC - Part B); 5 Level II codes). LCD with the same title: L34645, L35724, L36029, L36668
- A56915: Billing and Coding: Urine Drug Testing (WPS Insurance Corporation (MAC - Part A, MAC - Part B); 5 Level II codes). LCD with the same title: L34645, L35724, L36029, L36668
- A59723: Billing and Coding: Outpatient Psychotherapy (Palmetto GBA (MAC - Part A, MAC - Part B); 7 Level II codes). LCD with the same title: L39853
- A59416: Billing and Coding: Urine Drug Testing (Wellpoint Federal (MAC - Part A, MAC - Part B); 5 Level II codes). LCD with the same title: L34645, L35724, L36029, L36668
- A54799: Billing and Coding: Urine Drug Testing (Palmetto GBA (MAC - Part A, MAC - Part B); 5 Level II codes). LCD with the same title: L34645, L35724, L36029, L36668
- 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
- A56756: Billing and Coding: Home Health - Psychiatric Care (Palmetto GBA (HHH MAC); 5 Level II codes). LCD with the same title: L34561
- 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
3 more articles list F11.251.
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)
- F11.250 — Opioid dependence with opioid-induced psychotic disorder with…
- F11.259 — Opioid dependence with opioid-induced psychotic disorder, unspecified
- F11.20 — Opioid dependence, uncomplicated
- F11.21 — Opioid dependence, in remission
- 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
- F11.281 — 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 F11.251 (Opioid dependence with opioid-induced psychotic disorder…)?
Medicare covers items and services, not diagnoses. 18 Medicare billing and coding articles list F11.251 as a covered diagnosis for 42 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 F11.251?
The Level II codes from the policies most specific to this diagnosis are G0480 (Drug test(s), definitive, utilizing (1) drug…, 7 articles); G0483 (Drug test(s), definitive, utilizing (1) drug…, 7 articles); G0482 (Drug test(s), definitive, utilizing (1) drug…, 7 articles); G0481 (Drug test(s), definitive, utilizing (1) drug…, 7 articles); G0659 (Drug test(s), definitive, utilizing drug identification…, 7 articles). Code choice depends on the item supplied; check each code's descriptor.
Which Medicare policy articles list F11.251?
A59718 (Billing and Coding: Opioid Treatment Programs); A56850 (Billing and Coding: Psychiatric Partial Hospitalization Programs); A56685 (Billing and Coding: Partial Hospitalization Programs), and 15 more articles.
What is ICD-10-CM code F11.251?
F11.251 is the ICD-10-CM code for opioid dependence with opioid-induced psychotic disorder with hallucinations, in category F11 (Opioid related disorders), chapter 5: Mental, behavioral and neurodevelopmental disorders.
Next steps
- Run a reimbursement report for a device billed under G0480
- Watch G0480 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for G0480
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