Use of Medication-Assisted Treatment (MAT) - Medicare Only Claims (MBSF)

SAS Name
OUD_MAT_MEDICARE

This variable indicates whether a beneficiary met the criteria for the Use of MedicationAssisted Treatment (MAT) as of the end of the calendar year.

Comments

The condition variable requires beneficiaries to satisfy both claims criteria (a minimum number/type of Medicare claims that have the proper codes and occurred within a specified time period) and coverage criteria (Medicare FFS Part A and Part B coverage during the entire specified time period).

For use of Medication-Assisted Treatment (MAT), beneficiaries must have one or more drug claim (Medicare Part B, Medicare Part D, and/or Medicaid) with an NDC (national drug code) for opioid-MAT or one or more non-drug claim (Medicare Part B or Medicaid non-drug claim) with a HCPCs code during the two year period.

 You can find more detailed information on the criteria on the CCW website: https://www.ccwdata.org/web/guest/condition-categories

Source: CCW (derived)

Code Code value
0 Beneficiary did not meet claims criteria or have sufficient fee-for-service (FFS) coverage
1 Beneficiary met claims criteria but did not have sufficient FFS coverage
2 Beneficiary did not meet claims criteria but had sufficient FFS coverage
3 Beneficiary met claims criteria and had sufficient FFS coverage