Thank you for your inquiry about CMS138v13 (performance period 2025). A qualifying denominator encounter will be evaluated based on the following measure requirement: at least two visits (see definition 'Qualifying Visit During Measurement Period') or at least one preventive visit (see definition 'Preventive Visit During Measurement Period') during the measurement period. The CPT code 99457 is included in the value set "Virtual Encounter" (2.16.840.1.113883.3.464.1003.101.12.1089) because it is described as "treatment management services," which meets the intent of the value set to include concepts that represent an encounter using online modalities. CPT 99453 is not included in the value set because its definition indicates it is specific to setting up the patient with the equipment. You may review the codes in the "Virtual Encounter" value set in VSAC using this link: https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1089/expansion/eCQM%20Update%202024-05-02 . This measure contains three reporting rates, which aim to identify: patients who were screened for tobacco use (rate/population 1), patients who were identified as tobacco users and received a tobacco cessation intervention (rate/population 2), and a comprehensive look at the overall performance on tobacco screening and cessation intervention (rate/population 3). Please refer to the measure specifications for each population criteria's requirements: https://ecqi.healthit.gov/sites/default/files/ecqm/measures/CMS138v13.html . If you have questions about understanding measure requirements, you may refer to the "Guide for Reading eCQMs" for additional guidance. If you have questions regarding implementing the measure, you may refer to the "Implementation Checklist for eCQM Annual Update" for additional guidance. These resources can be found in the eCQI Resource Center: https://ecqi.healthit.gov/ep-ec?qt-tabs_ep=ecqm-resources&global_measure_group=eCQMs .