​Thank you for your inquiry for CMS156v11 Use of High-Risk Medications in Older Adults. Numerator 1a is met if two high-risk medications from the same drug class were ordered on different days during the measurement period, or that the medication was ordered once during the measurement period with at least one refill (to indicate two orders). If the high-risk medications are the same, that would also meet the requirement. The list of high-risk medications from the same drug class meeting Numerator 1a are specified by the CQL definition "Same High Risk Medications Ordered on Different Days" (see below). As an example, any codes within the value set "Cardiovascular, other" ( https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.1053/expansion/eCQM%20Update%202022-05-05 ) are considered high-risk medications from the same drug class, e.g., two orders of "nifedipine 10 MG Oral Capsule", or one order of "nifedipine 10 MG Oral Capsule" and one order of "disopyramide 100 MG Oral Capsule". Numerator 2 is similar in that the criteria is met if high-risk medication from the same drug class (or two same high-risk medications) were ordered on different days during the measurement period, or once during the measurement period with at least one refill. Same High Risk Medications Ordered on Different Days "More Than One Order"(["Medication, Order": "Anticholinergics, first generation antihistamines"]) union "More Than One Order"(["Medication, Order": "Anticholinergics, anti Parkinson agents"]) union "More Than One Order"(["Medication, Order": "Antispasmodics"]) union "More Than One Order"(["Medication, Order": "Antithrombotic"]) union "More Than One Order"(["Medication, Order": "Cardiovascular, alpha agonists, central"]) union "More Than One Order"(["Medication, Order": "Cardiovascular, other"]) union "More Than One Order"(["Medication, Order": "Central nervous system, antidepressants"]) union "More Than One Order"(["Medication, Order": "Central nervous system, barbiturates"]) union "More Than One Order"(["Medication, Order": "Central nervous system, vasodilators"]) union "More Than One Order"(["Medication, Order": "Central nervous system, other"]) union "More Than One Order"(["Medication, Order": "Endocrine system, estrogens with or without progestins"]) union "More Than One Order"(["Medication, Order": "Endocrine system, sulfonylureas, long duration"]) union "More Than One Order"(["Medication, Order": "Endocrine system, other"]) union "More Than One Order"(["Medication, Order": "Nonbenzodiazepine hypnotics"]) union "More Than One Order"(["Medication, Order": "Pain medications, skeletal muscle relaxants"]) union "More Than One Order"(["Medication, Order": "Pain medications, other"]) More than One Antipsychotic Order exists ( "More Than One Order"(["Medication, Order": "Antipsychotics"])) More than One Benzodiazepine Order exists ( "More Than One Order"(["Medication, Order": "Benzodiazepines"]))