Thank you for your inquiry regarding CMS966v4, Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED). Our understanding of this scenario is that a patient arrived at the ED without a STEMI diagnosis and was diagnosed with a STEMI during the ED encounter. The patient was then transferred to a PCI-capable facility and received the PCI at the receiving facility. Based on this, for the first question, we can confirm the patient is included in the measure denominator. The measure denominator captures all patients that arrive with a STEMI diagnoses or develops a STEMI during the ED encounter. For the second and third question, both facilities, the one that transfers the patient with a STEMI diagnosis and the facility that accepts a STEMI patient into the ED would receive a score. This measure captures the percentage of ED encounters for patients 18 years and older with a diagnosis of STEMI who received appropriate treatment, defined as fibrinolytic therapy within 30 minutes of ED arrival, PCI 90 minutes of ED arrival, or transfer to an Acute Care Facility within 45 minutes of ED arrival. As such, this case would be included in the measure’s denominator for both respective facilities, assuming none of the measure exclusion criteria apply.