Thank you for your inquiry regarding CMS50v12 Closing the Referral Loop: Receipt of Specialist Report. To clarify, the measurement period is January 1 through December 31. The January 1 through October 31 timeframe refers to the time window within the measurement period where only referrals made then will be considered for the denominator. This allows adequate time for the referring clinician to collect the consult report by the end of the measurement period, i.e., December 31. Using your example, if the referral was during the Jan 1 to Oct 31 2024 timeframe but the appointment with the specialist (consultant) did not occur until 2025 which is after the end of the measurement period, then this patient would not meet the numerator. Please refer to the Guidance section of the measure specification which states that eligible clinicians who refer patients towards the end of the performance period (i.e., October), should request that clinicians to whom they referred their patients share their consult reports as soon as possible in order for those patients to be counted in the measure numerator during the measurement period. When clinicians to whom patients are referred communicate the consult report as soon as possible with the referring clinician, it ensures that the communication loop is closed in a timely manner and that the data are included in the submission to CMS. We hope this helps.