Bipolar Disorder and Major Depression: Appraisal for alcohol or chemical substance use

Last updated: May 3, 2018

CMS Measure ID: CMS169v4
Version: 4
NQF Number: None
Measure Description:

Percentage of patients with depression or bipolar disorder with evidence of an initial assessment that includes an appraisal for alcohol or chemical substance use.

Initial Patient Population:

Patients 18 years of age or older at the start of the measurement period with a new diagnosis of unipolar depression or bipolar disorder during the first 323 days of the measurement period, and evidence of treatment for unipolar depression or bipolar disorder within 42 days of diagnosis. The existence of a 'new diagnosis' is established by the absence of diagnoses and treatments of unipolar depression or bipolar disorder during the 180 days prior to the diagnosis.

Denominator Statement:

Equals Initial Population

Denominator Exclusions:


Numerator Statement:

Patients in the denominator with evidence of an assessment for alcohol or other substance use following or concurrent with the new diagnosis, and prior to or concurrent with the initiation of treatment for that diagnosis.

(Note: the endorsed measure calls for the assessment to be performed prior to discussion of the treatment plan with the patient, but the current approach was considered more feasible in an EHR setting. The “Assessment for Alcohol or Other Drug Use” required in the numerator is meant to capture a provider's assessment of the patient's symptoms of substance use. The essence of the measure is to avoid treating the patient for unipolar depression or bipolar disorder without an assessment of their use of alcohol or other drugs.)

Numerator Exclusions:


Denominator Exceptions:


Measure Steward: Centers for Medicare and Medicaid Services
Domain: Effective Clinical Care
Next Version:
Previous Version:
Measure Score: Proportion
Improvement Notation:

Higher score indicates better quality


The intent of the measure is that the assessment be performed for a single episode for each patient. Due to current limitations of the eMeasure specification system, it is possible for there to be up to two treatment episodes per patient, identified through up to two index episodes. As a result, the numerator criteria of this measure can be satisfied if a substance use assessment is performed within either treatment episode. Future versions of the measure should address this issue.


Release Notes


  • Disclaimer updated.
  • eMeasure version number incremented.
  • Narrowed the criteria for the 'Initial Population' to equal the 'Denominator' to ease calculation burden.
  • NQF Number and Endorsed By fields updated to reflect measure no longer endorsed by NQF.


  • Introduced function 'satisfies all' to specify that qualifying events must meet all conditions from a set of conditions or 'satisfies any' to specify that qualifying events must meet at least one condition from a set of conditions to streamline expression logic.
  • Introduced occurrencing on variables to enforce that the same instance of a clinical event is used throughout the measure when the logic within the variable does not limit the event to a single instance, e.g., FIRST or MOST RECENT.
  • Introduced variables $BHEncounter and $Treatments to allow re-use of logical expressions and reduce redundancy/complexity.
  • Removed the 'Occurrence A' from 'Medication, order: BH Antidepressant medication' throughout the measure to enable the creation of a variable. The removal of this occurrence has no effect on the intent of the measure.
  • Replaced 'Measurement Start Date' and 'Measurement End Date' with 'Measurement Period' and as necessary replaced existing timing operator (e.g., replacing 'starts before start of' with 'starts before end of').
  • Replaced 'ORs' with 'Union of' operator to provide a mechanism for specifying that qualifying event(s) must be a member of at least one of the data elements being unioned (if appropriate for measure intent).
  • Replaced 'Patient Characteristic Birthdate' with 'Age at' operator.

Value Sets

No changes

External Resources