Opioid Treatment Costs Analysis
Explore the allowed and paid costs of inpatient opioid treatment based on ICD-10 diagnosis codes. Detailed data from 2020 to 2021 sheds light on averages, claim counts, and trends in treatment expenses for various opioid-related conditions.
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Allowed and Paid Costs Inpatient vs. Outpatient Opioid Claims based on Diagnosis Codes Rate and Form Compliance Division Commissioner Vicki Schmidt Director Julie Holmes Anthony Depner Research Analyst 6/10/2025
Query Information The pulled data was based on two different types of code, CPT procedure codes and ICD-10 diagnosis codes. As this created a lot of different information to display, both types of codes will be represented in two different reports. This report will be based on the ICD-10 diagnosis codes for opioid treatment. The information was also separated into inpatient treatment and outpatient treatment. 2020 through the third quarter of 2024 are the years of data being queried. The most common of these ICD-10 codes will be represented on the slide before the graphics. 2
All Inpatient ICD-10 Codes F11.10 Opioid abuse, uncomplicated F11.129 Opioid abuse with intoxication, unspecified F11.20 Opioid dependence, uncomplicated F11.21 Opioid dependence, in remission F11.221 Opioid dependence with intoxication delirium F11.229 Opioid dependence with intoxication, unspecified F11.23 Opioid dependence with withdrawal F11.24 Opioid dependence with opioid-induced mood disorder F11.288 Opioid dependence with other opioid-induced disorder 3
All Inpatient ICD-10 Codes (cont.) F11.251 Opioid dependence with opioid-induced psychotic disorder with hallucinations F11.93 Opioid use, unspecified with withdrawal F11.94 Opioid use, unspecified with opioid-induced mood disorder F11.951 Opioid use, unspecified with opioid-induced psychotic disorder with hallucinations F11.98 Opioid use, unspecified with other specified opioid-induced disorder F11.988 Opioid use, unspecified with other opioid- induced disorder 4
Inpatient 2020 Allowed Averages Paid Averages $25,000.00 $7,000.00 $21,891.00 $5,896.05 AVERAGE ALLOWED ($) $6,000.00 $20,000.00 AVERAGE PAID ($) $4,560.00 $5,000.00 $15,000.00 $4,000.00 $8,190.00 $2,129.70 $3,000.00 $10,000.00 $7,134.27 $1,846.05 $1,408.00 $2,000.00 $2,779.18 $5,000.00 $4,560.00 $1,000.00 $- $- F1110 F1120 F1123 F1124 F11251 F1110 F1120 F1123 F1124 F11251 Claim Counts 140 117 120 Note: The graphs between the years may have different codes. 100 CLAIM COUNT 80 60 32 40 20 1 1 1 5 0 F1110 F1120 F1123 F1124 F11251
Inpatient 2021 Allowed Averages Paid Averages $42,304.20 $9,179.25 $45,000.00 $10,000.00 $40,000.00 AVERAGE ALLOWED ($) $8,000.00 AVERAGE PAID ($) $35,000.00 $30,000.00 $6,000.00 $25,000.00 $2,759.33 $20,000.00 $4,000.00 $1,632.00 $15,000.00 $10,008.35 $2,221.17 $2,965.33 $2,842.67 $1,484.00 $10,000.00 $2,000.00 $1,632.00 $771.20 $746.06 $5,000.00 $771.20 $771.20 $- $- F1110 F1120 F1121 F1123 F1124 F1193 F11951 F1110 F1120 F1121 F1123 F1124 F1193 F11951 Claim Counts 300 275 250 CLAIM COUNT 200 150 100 35 50 3 2 2 1 1 6 0 F1110 F1120 F1121 F1123 F1124 F1193 F11951
Inpatient 2022 Allowed Averages Paid Averages $11,117.01 $11,117.01 $12,000.00 $12,000.00 AVERAGE ALLOWED ($) $10,000.00 $10,000.00 AVERAGE PAID ($) $6,097.77 $8,000.00 $8,000.00 $6,097.77 $5,360.22 $2,542.61 $6,000.00 $6,000.00 $3,687.20 $3,422.78 $4,000.00 $4,000.00 $2,853.27 $1,542.39 $2,000.00 $2,000.00 $1,542.39 $2,920.00 $2,853.27 $2,920.00 $- $- F1110 F1120 F11229 F1123 F1124 F11288 F1193 F1110 F1120 F11229 F1123 F1124 F11288 F1193 Claim Counts 400 360 350 300 CLAIM COUNT 250 200 150 100 59 50 4 2 1 1 1 7 0 F1110 F1120 F11229 F1123 F1124 F11288 F1193
Inpatient 2023 Allowed Averages Paid Averages $13,125.00 $14,000.00 $14,000.00 $12,225.00 $12,000.00 $12,000.00 AVERAGE ALLOWED ($) $9,897.39 AVERAGE PAID ($) $10,000.00 $10,000.00 $8,000.00 $8,000.00 $4,951.85 $4,073.95 $3,329.92 $6,000.00 $6,000.00 $4,689.76 $3,944.16 $1,975.00 $4,000.00 $4,000.00 $888.36 $2,000.00 $2,000.00 $- $- F1110 F1120 F11221 F1123 F1124 F1110 F1120 F11221 F1123 F1124 Claim Counts 700 619 600 CLAIM COUNT 500 400 300 200 59 100 2 2 1 8 0 F1110 F1120 F11221 F1123 F1124
Inpatient 2024 Q1 - Q3 Allowed Averages Paid Averages $8,546.89 $7,583.69 $9,000.00 $8,000.00 $8,000.00 AVERAGE ALLOWED($) $7,000.00 $6,280.15 $5,538.27 AVERAGE PAID($) $7,000.00 $6,000.00 $6,000.00 $5,000.00 $4,697.31 $4,024.14 $5,000.00 $4,000.00 $4,000.00 $2,648.99 $2,593.22 $2,802.95 $2,624.50 $3,000.00 $3,000.00 $2,000.00 $2,000.00 $925.00 $740.00 $1,000.00 $1,000.00 $- $- F1110 F1120 F11221 F1123 F1124 F1193 F1110 F1120 F11221 F1123 F1124 F1193 Claim Counts 837 900 800 700 CLAIM AMOUNT 600 500 400 300 200 55 100 9 2 2 1 9 0 F1110 F1120 F11221 F1123 F1124 F1193
Common Outpatient ICD-10 Codes F11.10 Opioid abuse, uncomplicated F11.120 Opioid abuse with intoxication, uncomplicated F11.129 Opioid abuse with intoxication, unspecified F11.13 Opioid abuse with withdrawal F11.14 Opioid abuse with opioid-induced mood disorder 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 F11.229 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 delusions 10
Common Outpatient ICD-10 Codes F11.251 Opioid dependence with opioid-induced psychotic disorder with hallucinations F11.288 Opioid dependence with other opioid-induced disorder F11.29 Opioid dependence with unspecified opioid-induced disorder F11.90 Opioid use, unspecified, uncomplicated F11.921 Opioid use, unspecified with intoxication delirium F11.93 Opioid use, unspecified with withdrawal F11.94 Opioid use, unspecified with opioid-induced mood disorder F11.951 Opioid use, unspecified with opioid-induced psychotic disorder with hallucinations F11.982 Opioid use, unspecified with opioid-induced sleep disorder F11.988 Opioid use, unspecified with other opioid-induced disorder F11.99 Opioid use, unspecified with unspecified opioid-induced disorder 11
Outpatient 2020 Allowed Averages Paid Averages $2,725.57 $2,675.57 $3,000.00 $3,000.00 AVERAGE ALLOWED ($) $2,278.84 AVERAGE APID ($) $15.44 $2,500.00 $2,500.00 $159.57 $913.48 $1,714.65 $701.95 $2,000.00 $2,000.00 $15.44 $1,021.96 $28.00 $343.24 $28.00 $1,500.00 $1,500.00 $868.15 $549.04 $115.39 $10.66 $10.66 $110.64 $343.24 $1,000.00 $1,000.00 $34.21 $500.00 $500.00 $43.21 $- $- F1110 F1120 F1121 F1123 F11250 F11251 F11288 F1129 F1190 F1193 F1199 F1110 F1120 F1121 F1123 F11250 F11251 F11288 F1129 F1190 F1193 F1199 Claim Counts 300 270 250 200 CLAIM COUNT 150 100 44 50 17 16 16 8 12 2 2 1 1 1 0 F1110 F1120 F1121 F1123 F11250 F11251 F11288 F1129 F1190 F1193 F1199
Outpatient 2021 Allowed Averages Paid Averages $1,989.60 $5,946.64 $7,000.00 $2,844.00 $7,000.00 $86.25 $5,946.64 AVERAGE ALLOWED ($) $1,321.46 $6,000.00 $6,000.00 $169.84 $320.83 $1,879.84 $4,890.66 $4,890.66 $1,613.08 AVERAGE PAID ($) $5,000.00 $171.56 $5,000.00 $193.39 $2,088.36 $1,276.69 $411.53 $4,000.00 $655.42 $93.14 $4,000.00 $256.67 $23.80 $113.11 $2,290.50 $8.64 $1,595.01 $3,000.00 $3,000.00 $23.80 $1,576.85 $8.64 $182.63 $197.25 $2,000.00 $186.57 $2,000.00 $1,000.00 $1,000.00 $113.11 $- $- F1110 F11120 F11129 F1113 F1120 F1121 F1123 F11251 F1129 F1190 F11921 F1193 F1194 F11951 F11982 F1199 F1110 F11120 F11129 F1113 F1120 F1121 F1123 F11251 F1129 F1190 F11921 F1193 F1194 F11951 F11982 F1199 Claim Counts 333 350 300 250 CLAIM COUNT 200 150 100 25 24 50 21 18 8 4 3 2 2 2 2 2 1 1 1 0 F1110 F11120 F11129 F1113 F1120 F1121 F1123 F11251 F1129 F1190 F11921 F1193 F1194 F11951 F11982 F1199 13
Outpatient 2022 Allowed Averages Paid Averages $3,000.00 $2,500.00 $1,630.90 $2,460.00 AVERAGE ALLOWED ($) $1,914.73 AVERAGE PAID ($) $2,500.00 $879.45 $2,000.00 $331.50 $1,366.18 $2,000.00 $1,500.00 $570.79 $440.36 $1,116.24 $331.50 $1,314.01 $1,500.00 $53.33 $23.48 $1,031.29 $23.48 $43.36 $1,000.00 $309.75 $1,000.00 $5.40 $276.55 $5.40 $500.00 $500.00 $33.01 $33.01 $- $- F1110 F11120 F1210 F1120 F1121 F1123 F1129 F1190 F1193 F11951 F1199 F1110 F11120 F1210 F1120 F1121 F1123 F1129 F1190 F1193 F11951 F1199 Claim Counts 400 363 350 300 CLAIM COUNT 250 200 150 100 34 50 17 16 15 9 9 14 2 1 1 1 0 F1110 F11120 F1210 F1120 F1121 F1123 F1129 F1190 F1193 F11951 F1199
Outpatient 2023 Allowed Averages Paid Averages $2,754.72 $2,207.76 $3,000.00 $2,500.00 $676.90 AVERAGE ALLOWED ($) AVERAGE PAID ($) $1,258.89 $2,500.00 $2,000.00 $1,085.96 $2,000.00 $1,500.00 $1,425.42 $241.11 $1,385.45 $1,143.79 $1,133.00 $1,500.00 $242.76 $283.46 $379.37 $18.27 $996.54 $15.99 $570.89 $367.36 $1,000.00 $1,000.00 $500.00 $500.00 $- $- F1110 F1120 F1121 F1123 F1124 F11251 F1190 F1193 F1199 F1110 F1120 F1121 F1123 F1124 F11251 F1190 F1193 F1199 Claim Counts 600 544 500 400 CLAIM COUNT 300 200 73 100 36 24 23 14 15 9 2 2 0 F1110 F1120 F1121 F1123 F1124 F11251 F1190 F1193 F1199
Outpatient 2024 Q1 - Q3 Allowed Averages Paid Averages $2,315.21 $2,500.00 $2,500.00 $2,007.10 $269.72 AVERAGE PAID($) AVERAGE ALLOWED($) $2,000.00 $2,000.00 $749.90 $878.51 $757.73 $269.72 $1,500.00 $1,500.00 $806.33 $1,132.06 $101.28 $899.45 $101.28 $1,000.00 $1,000.00 $653.26 $489.94 $439.09 $427.61 $427.61 $372.22 $500.00 $500.00 $100.90 $92.16 $58.40 $55.96 $- $- F1110 F11129 F1120 F1121 F1123 F1124 F11288 F1190 F11921 F1193 F1199 F1110 F11129 F1120 F1121 F1123 F1124 F11288 F1190 F11921 F1193 F1199 Claim Counts 800 703 700 600 CLAIM AMOUNT 500 400 300 200 61 100 33 32 32 24 3 2 1 1 1 16 0 F1110 F11129 F1120 F1121 F1123 F1124 F11288 F1190 F11921 F1193 F1199
Key Notes Many of the codes that have larger payment amounts often have very low number of claims. Often with these claims, there are more than one procedure going on at once, so it is all tied together in a singular claim. This helps explain the averages that are way above normal expected claim amounts. F11.20 (Opioid dependence, uncomplicated) was by far the most common ICD code across the five-year gap. This could be due to the F11.20 code encompasses many opioid dependence definitions since it is the uncomplicated code. On average, outpatient claims are significantly cheaper than inpatient claims. This is most likely tied to other procedures being processed on a single claim, and thus the price of the claim is much higher. 17
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