Written by Elizabeth Cairns, Mobilize Recovery Special Projects and Michael Masiowski, MD, reviewed by Code Recover Clinician Advisors, August 2026

Dr. Arianna Campbell talks about the need to increase reimbursement for hospitals and clinicians who are treating OUD effectively.

CPT and CMS Codes for Services Rendered

Properly coding for OUD services ensures the sustainability of your hospital's addiction programs. For ED providers, SBIRT (Screening, Brief Intervention, and Referral to Treatment) is a billable service. Using CPT codes 99408 (15-30 minutes) or 99409 (over 30 minutes) allows the provider to capture the time spent on motivational interviewing and peer coordination. Medicare has an equivalent code: G0396 (15-30 minutes) and G0397 (over 30 minutes). These codes can be billed in addition to standard E/M codes. Billing requires meeting and documenting the following elements:

• Time: the intervention must last at least 15 minutes. 99408/G0396 covers 15–30 minutes; 99409/G0397 covers interventions longer than 30 minutes.
• Tools: a standardized, validated screening tool must be used, and results must be entered.
• Intervention: the provider must perform a brief intervention, which involves discussing the results, assessing the patient's readiness to change, and providing feedback or advice.

CMS specifically allows for coding and billing of OUD treatment and referral through code G2213. This code is ED-specific and is for "initiation of medication for the treatment of opioid use disorder in the emergency department setting, including assessment, referral to ongoing care, and arranging access to supportive services." It is an add-on code, billed in addition to the ED E/M visit code. Involving a peer is the easiest and safest way of meeting the elements of G2213, which must be documented, and include:

• Assessing the patient for the appropriateness of OUD medication
• Initiation of the medication
• Arranging referral to follow-up care for ongoing OUD treatment

When initiating MOUD, prescribers should document the complexity of the medical decision-making. High-complexity E/M codes (e.g., 99285) are often appropriate for overdose reversals or complex inductions involving co-morbidities. Ensure the documentation reflects the "risk to life or bodily function" inherent in an acute overdose, especially if the patient meets criteria for Critical Care (code 99291).

Furthermore, many states now have specific codes for "Peer Support Services." While clinicians don't bill these directly, ensuring the peer's time is documented in the medical record may allow for facility-level reimbursement. Clear documentation of "time spent" is the most defensible way to ensure proper billing for these intensive, life-saving interactions.

ICD Codes for Diagnosis

ICD-10-CM classifies opioid use disorder under the F11 category, using the older terms "abuse" and "dependence" rather than the DSM-5 term "opioid use disorder." F11.1x (abuse) corresponds to mild OUD, and F11.2x (dependence) corresponds to moderate-to-severe OUD. For overdose and poisoning events, clinicians use the T40.0 through T40.6 codes, specifying accidental, intentional, assault, or undetermined intent. Polysubstance involvement is coded separately and is often inconsistently captured.

F11 Codes:

ICD-10 code F11 refers to opioid-related disorders. This category of mental and behavioral disorders classifies complications, abuse, and dependence involving drugs like heroin, morphine, and prescription painkillers. Subcategories are further expanded by exact clinical manifestations (e.g., uncomplicated, in remission, or with intoxication/withdrawal).

Specific and commonly used F11 subcategories include:

• F11.10 Opioid abuse, uncomplicated
• F11.11 Opioid abuse, in remission
• F11.129 Opioid abuse with intoxication, unspecified
• F11.20 Opioid dependence, uncomplicated
• F11.21 Opioid dependence, in remission
• F11.22 Opioid dependence with intoxication
• F11.23 Opioid dependence with withdrawal
• F11.90 Opioid use, unspecified, uncomplicated
• F11.99 Opioid use, unspecified with unspecified opioid-induced disorder 

For an exhaustive list of all specific fifth and sixth-character variations—including those with opioid-induced psychotic or mood disorders—visit the ICD-10 Data or AAPC Coder databases.

T40 Codes:

The ICD-10-CM category T40 encompasses poisonings, adverse effects, and underdosing of narcotics, opioids, and psychodysleptics (hallucinogens). Each subcategory typically branches into 6th-character variants covering accidental, intentional self-harm, assault, and undetermined intent. Seventh characters (A, D, S) designate the encounter type.

The primary T40 subcategories include:

• T40.0: Opium
• T40.1: Heroin
• T40.2: Other opioids (e.g., morphine, codeine, oxycodone)
• T40.3: Methadone
• T40.4: Other synthetic narcotics (e.g., fentanyl, tramadol, pethidine)
• T40.5: Cocaine
• T40.6: Other and unspecified narcotics
• T40.7: Cannabis (derivatives)
• T40.8: Lysergide (LSD)
• T40.9: Other and unspecified psychodysleptics [hallucinogens] (e.g., mescaline, PCP, psilocybin)

For the full list of specific drug agents and to find the exact 6th- and 7th-character extensions, use the comprehensive ICD-10 Data Lookup.

Using consistent coding practice is not only important for billing, but for accurate data retrieval as well– the codes that are searched by agencies reporting OUD incidence are the F11 and T40 codes, which means the true incidence of OUD is often underreported.