Overarching OUD Disorder (Any of the Three Sub-Indicators) - Medicare Only Claims

SAS Name

This variable is the Overarching Opioid Use Disorder (OUD) indicator, which identifies whether a beneficiary met any of the three opioid-related sub-Indicators as of the end of the calendar year. Beneficiaries who were identified as meeting the criteria for any of the following, also meet the criteria for this overarching indicator: OUD_DX_MEDICARE, OUD_HOSP_MEDICARE, or OUD_MAT_MEDICARE.


The condition variable requires beneficiaries to satisfy both claims criteria (a minimum number/type of Medicare claims that have the proper diagnosis 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 the overarching opioid use disorder indicator, beneficiaries must have met the criteria for at least one of the three opioid-use disorder sub-category conditions:

  • Diagnosis and Procedure Basis for OUD (OUD_DX_MEDICARE)
  • Opioid-Related Hospitalization or ED (OUD_HOSP_MEDICARE), or
  • Use of Medication-Assisted Treatment (MAT) (OUD_MAT_MEDICARE).

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