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  1. eCQM Issue Tracker
  2. CQM-7578

CPT Category II codes for HbA1c numerator calculation

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      Thank you for your inquiry about CMS122v13 (2025 Performance Period) and CMS122v12 (2024 Performance Period). This measure identifies an HbA1c lab test via QDM datatype "Laboratory Test, Performed" along with the value set "HbA1c Laboratory Test" (2.16.840.1.113883.3.464.1003.198.12.1013). As per the CMS Blueprint for Laboratory Test, Performed, CPT is not an acceptable terminology for this datatype. Therefore, you will need EMR documentation of laboratory test performed using any codes from the value set "HbA1c Laboratory Test" (2.16.840.1.113883.3.464.1003.198.12.1013), or documentation that can be mapped to any of the codes in this value set. Please keep in mind that if mapping is utilized, it is important to maintain proper documentation in case of a CMS audit. For further information on eCQM specifications, please refer to the eCQI resource center at https://ecqi.healthit.gov/ep-ec?qt-tabs_ep=0.
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      Thank you for your inquiry about CMS122v13 (2025 Performance Period) and CMS122v12 (2024 Performance Period). This measure identifies an HbA1c lab test via QDM datatype "Laboratory Test, Performed" along with the value set "HbA1c Laboratory Test" (2.16.840.1.113883.3.464.1003.198.12.1013). As per the CMS Blueprint for Laboratory Test, Performed, CPT is not an acceptable terminology for this datatype. Therefore, you will need EMR documentation of laboratory test performed using any codes from the value set "HbA1c Laboratory Test" (2.16.840.1.113883.3.464.1003.198.12.1013), or documentation that can be mapped to any of the codes in this value set. Please keep in mind that if mapping is utilized, it is important to maintain proper documentation in case of a CMS audit. For further information on eCQM specifications, please refer to the eCQI resource center at https://ecqi.healthit.gov/ep-ec?qt-tabs_ep=0 .
    • CMS0122v13
    • CMS0122v12
    • HbA1c numerator calculation

      Hi There,

      Some of our clients are sending CPT category II code for HbA1c test, can we use the same for numerator calculation for submission

      Most recent hemoglobin A1c level less than 7.0% use 3044F
      Most recent hemoglobin A1c (HbA1c) level greater than or equal to 7.0% and less than 8.0% use 3051F
      Most recent hemoglobin A1c (HbA1c) level greater than or equal to 8.0% and less than or equal to 9.0% use 3052F
      Most recent hemoglobin A1c level greater than 9.0% use 3046F 

      Thanks,
      Ramya.

            AIR EC eCQM Team AIR EC eCQM Team
            ramya.khasnis Ramya Khasnis
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