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Short SAS Name
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:

Source: CCW (derived)

CodeCode value
Beneficiary did not meet claims criteria or have sufficient fee-for-service (FFS) coverage
Beneficiary met claims criteria but did not have sufficient FFS coverage
Beneficiary did not meet claims criteria but had sufficient FFS coverage
Beneficiary met claims criteria and had sufficient FFS coverage