Thank you for your follow-up inquiry regarding CMS2v13: Preventive Care and Screening: Screening for Depression and Follow-Up Plan. Providers are not expected to screen at every encounter, and the measure is not intended to penalize providers when they fail to address screening at all visits. The assumption is that a provider only diagnoses bipolar disorder when there are clinical indications; therefore, once that diagnosis is present in the record and there are any subsequent encounters (with or without screening), the measure considers the patient excluded from measure consideration (clinically, they should be seeing a psychiatric care provider specific to those needs, which would also address depression). Please note that in eCQMs, denominator exclusions remove patients from the qualifying population before determining if they meet the numerator criteria.   Example: 1. Look at all qualifying encounters during measurement period 2. Determine if there was bipolar diagnosis prior to any of the qualifying encounters 3. If yes, exclude (and STOP evaluation) 4. If no, check to see if screened 1. If screened positive, was there follow-up… etc.     Addressing your follow-up question, while the value set is titled “Encounter to Screen for Depression Value Set”, they are encounters where one may screen for depression. Additionally, physical therapy and telehealth are included. If a visit during the measurement period meets a code in any of those value sets (hence the use of “union”), then they meet the qualifying encounter criterion.