Thank you for your question for CMS146v12, Appropriate Testing for Pharyngitis (2024 performance period). Denominator exclusions refine healthcare quality assessments by excluding specific individuals or events, ensuring that metrics apply to clinically relevant populations and account for circumstances where interventions may not be appropriate. This focuses improvement efforts on impactful areas. Moreover, denominator exclusions contribute to fair comparisons between healthcare entities. For this measure, specifically, the intent of the exclusions is to avoid penalizing entities for prescribing antibiotics when a patient may have other conditions besides pharyngitis for which an antibiotic is warranted. For further information on eCQM specifications, please refer to the eCQI resource center at https://ecqi.healthit.gov/ep-ec?qt-tabs_ep=0 .