​ Thank you for your question on CMS50, Closing the Referral Loop: Receipt of Specialist Report. We recommend that you review the Referral value set (2.16.840.1.113883.3.464.1003.101.11.1215) and look for SNOMED codes related to pain services management. One code that may be useful is SNOMED code 306265007 “referral to pain management specialist (procedure)". The AU Announcement provides further details and additional resources on how to find eCQM value sets, direct reference codes, and terminology information in the Value Set Authority Center, hosted by the National Library of Medicine. Regarding your follow up questions: Q1. If we did not get the consultant report from the 1st referral, can we satisfy the numerator by attaching the consultant report in the 2nd referral? No, you cannot satisfy the numerator by attaching the consultant report in a second or subsequent referral. This is explained in the Guidance section of the measure that states “only the first referral made between January 1 – October 31 of the measurement period will be considered for this measure to allow adequate time for the referring clinician to collect the consult report by the end of the measurement period. If there are multiple referrals for a patient during the measurement period, use the first referral.” Q2 Does pre-opt clearance from cardiologist or pre op lab counts towards consultant report? It is possible that a referral made for the purpose of obtaining preoperative clearance from a cardiologist would count as a consultant report. However, preoperative lab counts would not count as a consultant report since there is likely only lab results and no prescriptive guidance for the clinician who refers the patient included. Q3 Is there a minimum number required in the denominator ? In order to report on the measure, there must be at least one referral during the measurement period, and the measure only references the first referral in the event that there are multiple referrals. This is explained in the Guidance section of the measure that states “The consultant report that will successfully close the referral loop should be related to the first referral for a patient during the measurement period. If there are multiple consultant reports received by the referring clinician which pertain to a particular referral, use the first consultant report to satisfy the measure.”