Thank you for your inquiry about CMS138v11 (2023 performance period). Per measure specification, numerator 3 looks for "Patients who were screened for tobacco use at least once during the measurement period AND who received tobacco cessation intervention during the measurement period or in the six months prior to the measurement period if identified as a tobacco user". The logic/data criteria are specified in the body section of the specification. For example, a negative tobacco screening would qualify for numerator 3 and is defined by the "Most Recent Tobacco Use Screening Indicates Tobacco Non User" definition, which requires the most recent tobacco screening during the measurement period to have a result indicating tobacco non-user. This definition is further defined by these data/timing components: QDM datatype "Assessment, Performed" using a code from the value set "Tobacco Use Screening" (OID: 2.16.840.1.113883.3.526.3.1278), QDM attribute "relevantPeriod" or "relevantDateTime" during Measurement Period, and QDM attribute "result" using a code from the "Tobacco Non-User" value set (OID: 2.16.840.1.113883.3.526.3.1189), and etc. A positive tobacco screening with tobacco cessation interventions performed would also qualify for numerator 3. The corresponding definitions can be viewed in the eCQM specification. For additional guidance on how to read the eCQM specification, you may also refer to this resource available on the eCQI Resource Center, "Guide for Reading eCQMs":. Numerator: "Most Recent Tobacco Use Screening Indicates Tobacco Non User" is not null   or ( "Most Recent Tobacco Use Screening Indicates Tobacco User" is not null       and ( exists "Tobacco Cessation Counseling Given"           or exists "Tobacco Cessation Pharmacotherapy Ordered"           or exists "Active Pharmacotherapy for Tobacco Cessation"       )   ) Most Recent Tobacco Use Screening Indicates Tobacco Non User ( Last(["Assessment, Performed": "Tobacco Use Screening"] TobaccoUseScreening where Global."NormalizeInterval"(TobaccoUseScreening.relevantDatetime, TobaccoUseScreening.relevantPeriod)during "Measurement Period" sort by start of Global."NormalizeInterval"(relevantDatetime, relevantPeriod) )) MostRecentTobaccoUseScreening where MostRecentTobaccoUseScreening.result in "Tobacco Non User"