Thank you for your inquiry about CMS146v13 (2025 Performance Period). The intent of the measure's numerator is to assess patients who received a Group A Streptococcus test within a seven-day period, from three days prior to the episode date through three days after the episode date. A Group A strep test is identified using the QDM datatype "Laboratory Test, Performed," along with the value set "Group A Streptococcus Test," and identifies a non-null test result via the QDM attribute "result." A non-null result can be interpreted as any entry present in the electronic record, with no specific value or code required. This measure does not require a specific result (positive or negative) from the strep test. In your example, if a patient received a Group A Streptococcus test but also had a competing diagnosis on or three days after the episode date, they would be excluded from the measure. Please review the measure specification to understand the measure requirements: https://ecqi.healthit.gov/sites/default/files/ecqm/measures/CMS146v13.html . If you have questions about reading the measure specification or understanding data requirements, you may refer to the "Guide for Reading eCQMs" for additional guidance. This resource can be found in the eCQI Resource Center: https://ecqi.healthit.gov/ep-ec?qt-tabs_ep=ecqm-resources&global_measure_group=eCQMs .