Thank you for your question. With the introduction of CQL, the use of 'occurrences' within the measure logic was removed. However, the same concept is present when definitions are reused in a similar manner within other definitions, even when reused across different measure components (e.g., denominator, numerator). The definitions used within the numerator which require the "Cup to Disc Ratio" and the "Optic Disc Exam for Structural Abnormalities" with results, both reuse the encounter related definition which was introduced in the initial population. In CMS143 v7 (for 2019 implementation) and v8 (for 2020 implementation), this definition is called "Primary Open Angle Glaucoma Encounter". Since this definition is used as the anchor in the numerator, it is required that both the "Cup to Disc Ratio" and "Optic Disc Exam for Structural Abnormalities" occur during the same encounter. Please see the Initial Population criteria, which requires that 'Primary Open Angle Glaucoma Encounter' exists, then review the Numerator Criteria, which requires results for both "Cup to Disc Ratio" and "Optic Disc Exam for Structural Abnormalities". In the definitions section of the measure, both "Cup to Disc Ratio" and "Optic Disc Exam for Structural Abnormalities" include logic which requires that these both occur during the 'Primary Open Angle Glaucoma Encounter'.