Thank you for your inquiry about CMS156v13 (performance period 2025). Numerator 1a is met if two high-risk medications from the same drug class were ordered on different days during the measurement period, or that the medication was ordered once during the measurement period with at least one refill (to indicate two orders). If the high-risk medications are the same, that would also meet the requirement. In your example, if a patient was prescribed 1 mg of Scopolamine on 3/12/2025 with at least one refill, they would meet the criteria for Numerator 1a. The medication scopolamine or any code included in the "Potentially Harmful Gastrointestinal Antispasmodics for Older Adults" (2.16.840.1.113883.3.464.1003.1050) value set may be used satisfy numerator 1a requirement. Please reference the measure specification for the most updated list of high-risk medications considered for this measure as well as further details about measure requirements: https://ecqi.healthit.gov/sites/default/files/ecqm/measures/CMS156v13.html . If you need assistance reading an eCQM, please refer to the resources available at eCQI Resource Center, such as "Guide for Reading eCQMs" or "Implementation Checklist eCQM Annual Update": https://ecqi.healthit.gov/ep-ec?qt-tabs_ep=ecqm-resources .