CMS 137 clarification

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    • Type: EC eCQMs - Eligible Clinicians
    • Resolution: Answered
    • Priority: Moderate
    • Component/s: None
    • None
    • Mayo Clinic
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      Thank you for your inquiry regarding CMS137v14 (2026 performance period). The eCQMs are designed to use clinical data from structured fields in the EHR, as opposed to billing/claims data. The logic is specified such that if the providers are sharing an EHR or if data is being shared through Health Information Exchange, all providers that have access to the data would receive credit. Numerator 1 requires initiation of treatment, either an intervention or medication for the treatment of SUD within 14 days of a SUD episode. There are multiple pathways to meet Numerator 1 including psychosocial visit. For example, a psychosocial visit can be defined as an encounter with a diagnosis code using the codes in the value sets "Virtual Encounter" (2.16.840.1.113883.3.464.1003.101.12.1089) and "Substance Use Disorder" (2.16.840.1.113883.3.464.1003.106.12.1001). Please refer to the measure specification to review the measure requirements: https://ecqi.healthit.gov/sites/default/files/ecqm/measures/CMS137-v14.0.000-QDM.html. If you have questions regarding implementing the measure, you may refer to the "Implementation Checklist for eCQM Annual Update" for additional guidance. These resources can be found in the eCQI Resource Center: https://ecqi.healthit.gov/ep-ec?qt-tabs_ep=ecqm-resources&global_measure_group=eCQMs.
      Show
      Thank you for your inquiry regarding CMS137v14 (2026 performance period). The eCQMs are designed to use clinical data from structured fields in the EHR, as opposed to billing/claims data. The logic is specified such that if the providers are sharing an EHR or if data is being shared through Health Information Exchange, all providers that have access to the data would receive credit. Numerator 1 requires initiation of treatment, either an intervention or medication for the treatment of SUD within 14 days of a SUD episode. There are multiple pathways to meet Numerator 1 including psychosocial visit. For example, a psychosocial visit can be defined as an encounter with a diagnosis code using the codes in the value sets "Virtual Encounter" (2.16.840.1.113883.3.464.1003.101.12.1089) and "Substance Use Disorder" (2.16.840.1.113883.3.464.1003.106.12.1001). Please refer to the measure specification to review the measure requirements: https://ecqi.healthit.gov/sites/default/files/ecqm/measures/CMS137-v14.0.000-QDM.html . If you have questions regarding implementing the measure, you may refer to the "Implementation Checklist for eCQM Annual Update" for additional guidance. These resources can be found in the eCQI Resource Center: https://ecqi.healthit.gov/ep-ec?qt-tabs_ep=ecqm-resources&global_measure_group=eCQMs .
    • CMS0137v14
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      We are implementing the CMS 137 Initiation & Engagement of Substance Use Disorder (SUD) Treatment (IET) measure using the eCQM collection method (not claims-based or CQM collection methods). We'd like clarification on how services provided outside of our organization—such as community MAT programs or behavioral health providers—can be handled within the eCQM logic. Many of our sites to not have behavioral health services internally and refer to external community partners.
      Show
      We are implementing the CMS 137 Initiation & Engagement of Substance Use Disorder (SUD) Treatment (IET) measure using the eCQM collection method (not claims-based or CQM collection methods). We'd like clarification on how services provided outside of our organization—such as community MAT programs or behavioral health providers—can be handled within the eCQM logic. Many of our sites to not have behavioral health services internally and refer to external community partners.

      Specifications indicate that a SUD Diagnosis code and an eligible visit code are necessary for the qualifying psychosocial visit for numerator compliance. If services are provided in the community, we would not likely have access to the billing data from the community providers. Without increasing care team documentation burden, are there best practices for capturing and crediting external services within the context of eCQM reporting for this measure?

      We’re also concerned that if clinicians see their care efforts—especially coordination and external referrals—not reflected in measure performance, it may reduce their engagement and adoption of the workflows needed to support this ACO required measure.

      We want to ensure our documentation workflows align with the intent of the measure and allow full credit for care being delivered, even when outside our direct EHR environment.

            Assignee:
            AIR EC eCQM Team
            Reporter:
            Amanda Fredricksen
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              Created:
              Updated:
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