Thank you for your inquiry for CMS122v10 “Diabetes: Hemoglobin A1c (HbA1c) Poor Control (> 9%)” (2022 performance period). We do not include consultations (CPT 99241, 99242, 99243, 99244, 99245) in the "Office Visit" value set used in the denominator because they can be of limited time and the clinician might not have a meaningful relationship with the patient. We try to attribute patients to clinicians that have an ongoing relationship with the patient. Conversely, these consultation codes are included in the "Outpatient" value set for the exclusion in order to identify patients with an advanced illness diagnosis.

In measures such as CMS122 the QDM data elements in the specifications include: • "Encounter, Performed: Office Visit" using "Office Visit (2.16.840.1.113883.3.464.1003.101.12.1001)" • "Encounter, Performed: Outpatient" using "Outpatient (2.16.840.1.113883.3.464.1003.101.12.1087)" We would like to understand why the office consultation codes CPT 99241 , 99242, 99243, 99244, 99245 are not included in the office visit value set used to identify a qualifying encounter, but are included in the outpatient encounter value set used to identify the outpatient visits for the advanced illness exclusion.