Thank you for your questions about CMS506v4 Safe Use of Opioids – Concurrent Prescribing. In response to your first and second questions, the Safe Use of Opioids measure captures the proportion of patients 18 years of age and older who are prescribed, or continued on, two or more opioids or an opioid and benzodiazepine concurrently at discharge. This includes medications prescribed to patients by non-hospital clinicians prior to admission to the inpatient stay. The measure is intended to reduce risk to the patient based on all opioids and benzodiazepines they are taking at discharge, regardless of prescriber, and encourages clinicians to carefully evaluate all of the patient's medication at discharge. In response to your third and fourth questions, the Safe Use of Opioids measure only excludes cancers that are active at the time the patient is discharged, not patients who have a history of cancer but are in remission. Please use the value set All Primary and Secondary Cancer (2.16.840.1.113762.1.4.1111.161) to identify cancers eligible for denominator exclusion. Value sets can be reviewed on the Value Set Authority Center (VSAC) by creating an account at https://vsac.nlm.nih.gov/ . If the active pelvic tumor is identified as a primary or secondary cancer listed in the value set, the patient will be excluded from the denominator. If the tumor is not identified as a primary or secondary cancer listed in the above value set, the patient should remain in the measure denominator unless they meet another exclusion criteria. Please let us know if you have any additional questions.