Thank you for your inquiry for CMS165v12. A qualifying encounter is required to meet denominator, however, the blood pressure reading evaluated in the numerator does not need to be associated with the qualifying encounter in the denominator or any other qualifying encounter. The measure looks for the most recent systolic/diastolic blood pressure reading NOT taken during an acute inpatient stay or an emergency department visit. Additional guidance on qualifying blood pressure readings can be found in the measure specification's "Guidance" section. Please review the measure specification for further details about measure requirements: https://ecqi.healthit.gov/sites/default/files/ecqm/measures/CMS165v12.html . If you need assistance reading an eCQM, please refer to the resources available at eCQI Resource Center, such as "Guide for Reading eCQMs" or "Implementation Checklist eCQM Annual Update": https://ecqi.healthit.gov/ep-ec?qt-tabs_ep=ecqm-resources&global_measure_group=eCQMs .