OUD Diagnosis Code

60 -OUD Diagnosis Code (Rev. 13147; Issued: 03-28-25; Effective: 01-01-25; Implementation: 03-25-25) Consistent with statutory provisions under sections 1861(s)(2)(HH), 1861(jjj)(1), and 1834 of the Act, Medicare payment made under Part B to OTPs furnishing OUD treatment services must be for the treatment of an OUD. Professional claims submitted on form CMS-1500 (or the electronic equivalent form 837P) and institutional claims submitted on form CMS-1450 must include an OUD diagnosis. These diagnosis codes must apply to HCPCS G-codes representing both the bundled payments for an episode of care and add-on codes to the bundled payments. Applicable diagnosis codes for an OUD that must be submitted on claims include ICD-10-CM codes in the F11 range for “disorders related or resulting from abuse or misuse of opioids” : https://www.icd10data.com/ICD10CM/Codes/F01-F99/F10-F19/F11-.