Thank you for your question regarding CMS155v12, Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents, specifically the Initial Population/Denominator criteria.
The intent of this measure is to look for encounters performed by primary care providers (PCPs) or obstetrician/gynecologists (OB/GYNs) acting in a primary care capacity to provide the encounter to meet the Initial Population [“Patients 3-17 years of age by the end of the measurement period, with at least one outpatient visit with a primary care physician (PCP) or an obstetrician/gynecologist (OB/GYN) during the measurement period”].
However, the denominator encounter logic/codes are not provider specific. As specified in the measure logic, visits that would qualify for the Initial Population are those encoded with any codes listed in the value sets from the "Qualifying Encounters" definition.
Qualifying Encounters
( ["Encounter, Performed": "Office Visit"]
union ["Encounter, Performed": "Preventive Care Services Individual Counseling"]
union ["Encounter, Performed": "Preventive Care, Established Office Visit, 0 to 17"]
union ["Encounter, Performed": "Preventive Care Services, Initial Office Visit, 0 to 17"]
union ["Encounter, Performed": "Preventive Care Services Group Counseling"]
union ["Encounter, Performed": "Home Healthcare Services"]
union ["Encounter, Performed": "Telephone Visits"] ) ValidEncounters
where ValidEncounters.relevantPeriod during day of "Measurement Period"
You can reference the applicable codes containing these value sets on the Value Set Authority Center (VSAC) at
https://vsac.nlm.nih.gov/. Click on the “Search Value Sets” tab and enter the value set ID to review codes included in the respective value set. For 2024 (PY2025), providers can decide which measures they want to report and need to apply the necessary restrictions at the individual provider level. For questions regarding specialty group reporting requirements, please submit questions to the QPP helpdesk. The Center for Clinical Standards & Quality (CCSQ) acts as the ‘helpdesk’ for QPP. Please reference the contact information for the CCSQ Support Center, that can be found at:
https://qualitynet.cms.gov/support