Thank you for inquiry on CMS2v14: Preventive Care and Screening: Screening for Depression and Follow-Up Plan. The measure allows the use of Denominator Exception criteria to include medical reasons for not completing the depression screening. The intent of the "medical reason" Denominator Exception is for situations where the patient has “cognitive, functional, or motivational limitations that may impact accuracy of results; patient is in an urgent or emergent situation where time is of the essence and to delay treatment would jeopardize the patient's health status”. Thus, if the patient has cognitive, functional, or motivational limitations that may impact accuracy of results or delaying treatment would jeopardize the patient's health status, then it would be appropriate to use the medical reason denominator exception. Note, that denominator exception (i.e., medical exception) would remove the patient from the denominator of the performance rate only if the numerator criteria are not met. You do not need to document the denominator exception to every qualifying encounter after it was documented earlier in that measurement period.