CMS137v14 Initiation and Engagement of Substance Use Disorder Treatment

Measure: Percentage of patients 13 years of age and older with a new substance use disorder (SUD) episode who received the following (Two rates are reported):

  1. Percentage of patients who initiated treatment, including either an intervention or medication for the treatment of SUD, within 14 days of the new SUD episode.
  2. Percentage of patients who engaged in ongoing treatment, including two additional interventions or medication treatment events for SUD, or one long-acting medication event for the treatment of SUD, within 34 days of the initiation.
Measure Type High Priority Measure Scoring
Process No A higher percentage indicates better quality
Denominator

Patients 13 years of age and older as of the start of the measurement period who were diagnosed with a new SUD episode during a visit between January 1 and November 14 of the measurement period
Numerator

Numerator 1: Initiation of treatment includes either an intervention or medication for the treatment of SUD within 14 days of the new SUD episode.

Numerator 2: Engagement in ongoing SUD treatment within 34 days of initiation includes:

  1. A long-acting SUD medication on the day after the initiation through 34 days after the initiation of treatment.

  2. One of the following options on the day after the initiation of treatment through 34 days after the initiation of treatment: a) two engagement visits, b) two engagement medication treatment events, c) one engagement visit and one engagement medication treatment event.
Denominator Exceptions

None
Denominator Exclusions

Exclude patients who are in hospice care for any part of the measurement period

Patients who meet the following criteria will be included in the denominator:

  • Age is 13 years or older at the start of the measurement period

  • AND have a diagnosis of a new SUD episode during a visit between January 1 and November 14 of the Measurement Period

  • AND have no history of SUD diagnosis or treatment

  • CPT: 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99281, 99282, 99283, 99284, 99285, 99221, 99222, 99223, 99234, 99235, 99236, 99238, 99239, 98008, 98009, 98010, 98011, 98012, 98013, 98014, 98015, 98966, 98967, 98968, 99441, 99442, 99443,  98970, 98971, 98972, 98980, 98981, 99421, 99422, 99423, 99457, 99458

  • HCPCS: G0071, G2010, G2012, G2250, G2251, G2252

Diagnoses are documented in the Assessment tab of an encounter. A comprehensive list of eligible diagnosis codes for substance use disorders can be located here.

  • A patient will not be included in the denominator if they have had a SUD 60 days prior to their first SUD during the Measurement Period.

Patients who have an order for or are receiving hospice care during the Measurement Period will be excluded from this measure.

To document hospice care ambulatory services, go to Encounter > Orders/Procedure > Orders/Referrals and click Add to add one of the eligible codes listed below:

CPT: 99377, 99378

HCPCS: G0182

Order Status must be marked as Pending or Complete.

To document hospice care encounter services, go to Encounter > Orders/Procedure > Orders/Referrals and click Add to add one of the eligible codes listed below:

HCPCS: G9473, G9474, G9475, G9476, G9477, G9478, G9479, Q5003, Q5004, Q5005, Q5006, Q5007, Q5008, Q5010, S9126, T2042, T2043, T2044, T2045, T2046

Order Status must be marked as Complete.

A patient will be counted in numerator 1 if the patient receives either an intervention or medication for the treatment of SUD within 14 days of the new SUD episode.

To document an intervention, the following codes are eligible:

  • CPT: 90832, 90834, 90837, 98008, 98009, 98010, 98011, 98012, 98013, 98014, 98015, 98966, 98967, 98968, 99441, 99442, 99443, 98970, 98971, 98972, 98980, 98981, 99421, 99422, 99423, 99457, 99458

  • HCPCS: G2067, G2068, G2069, G2070, G2071, G2072, G2073, G2074, G2075, G2076, G2077, G2080, G2086, G2087, H0020, H0033, G0071, G2010, G2012, G2250, G2251, G2252

  • To prescribe a medication for substance use disorder, go to Encounter > Medications > Manage/Prescribe Meds > New Prescription or Chart > Medications/Assessments > Modify. A comprehensive list of eligible medications can be located here.

A patient will be counted in numerator 2 if one of the following are met within 34 days of the new SUD episode:

  • Has treatment engagement with long acting medication

  • Has two or more treatment engagements with short acting medications or non medication interventions

To prescribe a medication for substance use disorder, go to Encounter > Medications > Manage/Prescribe Meds > New Prescription or Chart > Medications/Assessments > Modify. A comprehensive list of eligible medications can be located here.

To document an intervention, the following codes are eligible:

  • CPT: 90832, 90834, 90837, 98008, 98009, 98010, 98011, 98012, 98013, 98014, 98015, 98966, 98967, 98968, 99441, 99442, 99443, 98970, 98971, 98972, 98980, 98981, 99421, 99422, 99423, 99457, 99458

  • HCPCS: G2067, G2068, G2069, G2070, G2071, G2072, G2073, G2074, G2075, G2076, G2077, G2080, G2086, G2087, H0020, H0033, G0071, G2010, G2012, G2250, G2251, G2252

https://ecqi.healthit.gov/ecqm/ec/2026/cms0137v14

 

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