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Source1

{
  "resourceType": "ValueSet",
  "id": "2.16.840.1.113883.3.464.1003.106.11.1036",
  "meta": {
    "versionId": "5",
    "lastUpdated": "2023-12-21T17:43:03.000-05:00",
    "profile": [
      "http://hl7.org/fhir/StructureDefinition/shareablevalueset",
      "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/computable-valueset-cqfm",
      "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/publishable-valueset-cqfm"
    ]
  },
  "extension": [
    {
      "url": "http://hl7.org/fhir/StructureDefinition/valueset-author",
      "valueContactDetail": {
        "name": "NCQA PHEMUR Author"
      }
    },
    {
      "url": "http://hl7.org/fhir/StructureDefinition/resource-lastReviewDate",
      "valueDate": "2025-02-03"
    },
    {
      "url": "http://hl7.org/fhir/StructureDefinition/valueset-effectiveDate",
      "valueDate": "2021-02-20"
    }
  ],
  "url": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.106.11.1036",
  "identifier": [
    {
      "system": "urn:ietf:rfc:3986",
      "value": "urn:oid:2.16.840.1.113883.3.464.1003.106.11.1036"
    }
  ],
  "version": "20210220",
  "name": "SubstanceUseDisorderTreatment",
  "title": "Substance Use Disorder Treatment",
  "status": "active",
  "experimental": false,
  "date": "2021-02-20T01:02:00-05:00",
  "publisher": "NCQA PHEMUR",
  "jurisdiction": [
    {
      "coding": [
        {
          "system": "urn:iso:std:iso:3166",
          "code": "US"
        }
      ]
    }
  ],
  "purpose": "(Clinical Focus: The purpose of this value set is to represent concepts for encounters for substance use disorder treatment.),(Data Element Scope: This value set may use a model element related to Intervention.),(Inclusion Criteria: Includes concepts that represent an encounter for substance use disorder treatment.),(Exclusion Criteria: No exclusions.)",
  "compose": {
    "include": [
      {
        "system": "http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets",
        "concept": [
          {
            "code": "G2067",
            "display": "Medication assisted treatment, methadone; weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing, if performed (provision of the services by a medicare-enrolled opioid treatment program)"
          },
          {
            "code": "G2068",
            "display": "Medication assisted treatment, buprenorphine (oral); weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a medicare-enrolled opioid treatment program)"
          },
          {
            "code": "G2069",
            "display": "Medication assisted treatment, buprenorphine (injectable); weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a medicare-enrolled opioid treatment program)"
          },
          {
            "code": "G2070",
            "display": "Medication assisted treatment, buprenorphine (implant insertion); weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a medicare-enrolled opioid treatment program)"
          },
          {
            "code": "G2071",
            "display": "Medication assisted treatment, buprenorphine (implant removal); weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a medicare-enrolled opioid treatment program)"
          },
          {
            "code": "G2072",
            "display": "Medication assisted treatment, buprenorphine (implant insertion and removal); weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a medicare-enrolled opioid treatment program)"
          },
          {
            "code": "G2073",
            "display": "Medication assisted treatment, naltrexone; weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a medicare-enrolled opioid treatment program)"
          },
          {
            "code": "G2074",
            "display": "Medication assisted treatment, weekly bundle not including the drug, including substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a medicare-enrolled opioid treatment program)"
          },
          {
            "code": "G2075",
            "display": "Medication assisted treatment, medication not otherwise specified; weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing, if performed (provision of the services by a medicare-enrolled opioid treatment program)"
          },
          {
            "code": "G2076",
            "display": "Intake activities, including initial medical examination that is a complete, fully documented physical evaluation and initial assessment by a program physician or a primary care physician, or an authorized healthcare professional under the supervision of a program physician qualified personnel that includes preparation of a treatment plan that includes the patient's short-term goals and the tasks the patient must perform to complete the short-term goals; the patient's requirements for education, vocational rehabilitation, and employment; and the medical, psycho- social, economic, legal, or other supportive services that a patient needs, conducted by qualified personnel (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure"
          },
          {
            "code": "G2077",
            "display": "Periodic assessment; assessing periodically by qualified personnel to determine the most appropriate combination of services and treatment (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure"
          },
          {
            "code": "G2080",
            "display": "Each additional 30 minutes of counseling in a week of medication assisted treatment, (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure"
          },
          {
            "code": "G2086",
            "display": "Office-based treatment for opioid use disorder, including development of the treatment plan, care coordination, individual therapy and group therapy and counseling; at least 70 minutes in the first calendar month"
          },
          {
            "code": "G2087",
            "display": "Office-based treatment for opioid use disorder, including care coordination, individual therapy and group therapy and counseling; at least 60 minutes in a subsequent calendar month"
          },
          {
            "code": "H0020",
            "display": "Alcohol and/or drug services; methadone administration and/or service (provision of the drug by a licensed program)"
          },
          {
            "code": "H0033",
            "display": "Oral medication administration, direct observation"
          }
        ]
      }
    ]
  },
  "expansion": {
    "identifier": "urn:uuid:74b7cac8-d11f-4d14-b11a-a5e96f70e25f",
    "timestamp": "2025-05-23T22:14:00-04:00",
    "total": 13,
    "contains": [
      {
        "system": "http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets",
        "version": "2025",
        "code": "G2067",
        "display": "Medication assisted treatment, methadone; weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing, if performed (provision of the services by a medicare-enrolled opioid treatment program)"
      },
      {
        "system": "http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets",
        "version": "2025",
        "code": "G2068",
        "display": "Medication assisted treatment, buprenorphine (oral); weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a medicare-enrolled opioid treatment program)"
      },
      {
        "system": "http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets",
        "version": "2025",
        "code": "G2069",
        "display": "Medication assisted treatment, buprenorphine (injectable) administered on a monthly basis; bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a medicare-enrolled opioid treatment program)"
      },
      {
        "system": "http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets",
        "version": "2025",
        "code": "G2073",
        "display": "Medication assisted treatment, naltrexone; weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a medicare-enrolled opioid treatment program)"
      },
      {
        "system": "http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets",
        "version": "2025",
        "code": "G2074",
        "display": "Medication assisted treatment, weekly bundle not including the drug, including substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a medicare-enrolled opioid treatment program)"
      },
      {
        "system": "http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets",
        "version": "2025",
        "code": "G2075",
        "display": "Medication assisted treatment, medication not otherwise specified; weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing, if performed (provision of the services by a medicare-enrolled opioid treatment program)"
      },
      {
        "system": "http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets",
        "version": "2025",
        "code": "G2076",
        "display": "Intake activities, including initial medical examination that is conducted by an appropriately licensed practitioner and preparation of a care plan, which may be informed by administration of a standardized, evidence-based social determinants of health risk assessment to identify unmet health-related social needs, and that includes the patient's goals and mutually agreed-upon actions for the patient to meet those goals, including harm reduction interventions; the patient's needs and goals in the areas of education, vocational training, and employment; and the medical and psychiatric, psychosocial, economic, legal, housing, and other recovery support services that a patient needs and wishes to pursue, conducted by an appropriately licensed/credentialed personnel (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to each primary code"
      },
      {
        "system": "http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets",
        "version": "2025",
        "code": "G2077",
        "display": "Periodic assessment; assessing periodically by an otp practitioner and includes a review of moud dosing, treatment response, other substance use disorder treatment needs, responses and patient-identified goals, and other relevant physical and psychiatric treatment needs and goals; assessment may be informed by administration of a standardized, evidence-based social determinants of health risk assessment to identify unmet health-related social needs, or the need and interest for harm reduction interventions and recovery support services (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to each primary code"
      },
      {
        "system": "http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets",
        "version": "2025",
        "code": "G2080",
        "display": "Each additional 30 minutes of counseling in a week of medication assisted treatment, (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure"
      },
      {
        "system": "http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets",
        "version": "2025",
        "code": "G2086",
        "display": "Office-based treatment for opioid use disorder, including development of the treatment plan, care coordination, individual therapy and group therapy and counseling; at least 70 minutes in the first calendar month"
      },
      {
        "system": "http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets",
        "version": "2025",
        "code": "G2087",
        "display": "Office-based treatment for opioid use disorder, including care coordination, individual therapy and group therapy and counseling; at least 60 minutes in a subsequent calendar month"
      },
      {
        "system": "http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets",
        "version": "2025",
        "code": "H0020",
        "display": "Alcohol and/or drug services; methadone administration and/or service (provision of the drug by a licensed program)"
      },
      {
        "system": "http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets",
        "version": "2025",
        "code": "H0033",
        "display": "Oral medication administration, direct observation"
      }
    ]
  }
}