Measure Title: Opioid Withdrawal: Initiation of Medication-Assisted Treatment (MAT) and Referral to Outpatient Opioid Treatment
Measure Description: Percentage of Patients Presenting with Opioid Withdrawal Who Were Given Medication-Assisted Treatment and Referred to Outpatient Opioid Treatment
Denominator:Any patient evaluated by the Eligible Professional in the Emergency Department, Urgent Care, Clinic,
Inpatient, or Observation Status settings (E/M Codes 99234-99236, 99238-99239, 99281-99285, 99291-
99292, 99202-99205, 99212-99215 AND Place of Service Indicator: 02, 11, 19, 20, 21, 22, 23 OR equivalent in standardized code sets) PLUS
- Diagnosis of opioid abuse or dependence with withdrawal
- ICD-10: F11.13, F11.23
- Transferred to another acute care facility (same or higher level of care), eloped, AMA or expired
patients are excluded (V0704)
Numerator: Patients Who Were Given Medication for Opioid Use Disorder (MOUD) and, at Time of Discharge
to Home or Home Health, Referred to Outpatient Opioid Treatment
- Performance Met (VE281): Buprenorphine, Naltrexone or Methadone ordered AND, at time of
discharge to home or home health, outpatient opioid treatment referral made. - Medical Performance Exclusion (Denominator Exception) (VE282): Refusal of care, allergy to medicine, altered mental status, or risk for precipitated withdrawal.
- Performance Not Met (VE283): Buprenorphine, Naltrexone or Methadone not ordered OR Buprenorphine, Naltrexone or Methadone ordered BUT outpatient opioid treatment referral not made at time of discharge to home or home health.
• Note: Combination therapies ordered that include Buprenorphine or Methadone (such as Suboxone)
are also acceptable.
• Note: For patients who are not discharged in an encounter, an order of Buprenorphine or Methadone
is sufficient to meet the Numerator criteria.
Denominator Exclusions: None
Denominator Exceptions: Medical Performance Exclusion (Denominator Exception): Refusal of care, allergy to medicine, altered mental status, Buprenorphine or Methadone not clinically indicated
NQF ID Number: N/A
NQS Domain: Patient Safety
High Priority Measure: Yes
Measure Type: Process
Includes Teleheatlh: Yes
Inverse Measure: No
Proportional Measure: Yes
Continuous Variable Measure: No
Ratio Measure: No
Number of performance rates to be calculated and submitted: 1
Risk-Adjusted Status: No
Care Setting: Ambulatory; Ambulatory Care: Clinician Office/Clinic; Ambulatory Care: Hospital; Ambulatory Care: Urgent Care; Emergency Department and Services; Hospital; Hospital Inpatient; Hospital Outpatient; Outpatient Services
Submission Pathway: Traditional MIPS