Additional HCPCS for Substance Use Disorder Treatment Value Set

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    • Type: EC eCQMs - Eligible Clinicians
    • Resolution: Answered
    • Priority: Moderate
    • Component/s: None
    • None
    • Jeremy Morgan
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      Thank you for your inquiry about CMS137v13 and v14. Published versions of the measures in the Quality Payment Program cannot be changed after publication. The measure steward, the National Committee for Quality Assurance, will consider adding these codes in the next iteration of this measure.
      Show
      Thank you for your inquiry about CMS137v13 and v14. Published versions of the measures in the Quality Payment Program cannot be changed after publication. The measure steward, the National Committee for Quality Assurance, will consider adding these codes in the next iteration of this measure.
    • CMS0137v13
    • CMS0137v12
    • There are HCPCS codes that for Substance Use Disorder Treatment that are not included in the Value Set that should that are used when treating patients for substance use disorder.

      The code set for the Substance Use Disorder Treatment is missing some codes that are used in clinical practice and not catching all of the potential treatments that could be billed for and therefore are not being included in the numerator. 

      2.16.840.1.113883.3.464.1003.106.12.1005

      See below for the list of codes that need to be added to the Value Set.

      H0015 Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 3 hours/day and at least 3 days/week and is based on an individualized treatment plan), including assessment, counseling; crisis intervention, and activity therapies or education HCPCS
      H0016 Alcohol and/or drug services; medical/somatic (medical intervention in ambulatory setting) HCPCS
      H0005 Alcohol and/or drug services; group counseling by a clinician HCPCS
      H0006 Alcohol and/or drug services; case management HCPCS
      H0007 Alcohol and/or drug services; crisis intervention (outpatient) HCPCS
      T1006 Alcohol and/or substance abuse services, family/couple counseling HCPCS
      T1007 Alcohol and/or substance abuse services, family/couple counseling HCPCS
      H2035 An hour of outpatient alcohol/other drug treatment services HCPCS
      H2036 Alcohol and/or other drug treatment program, per diem HCPCS

       

            Assignee:
            AIR EC eCQM Team
            Reporter:
            Jeremy Morgan
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