Thank you for your question on CMS154v13 (2025 Performance Period). The measure does not exclude patients with surgical intervention after trauma. The measure looks for qualifying encounters with a diagnosis of URI in the initial population and excludes those where a patient had a comorbid condition, competing diagnosis, antibiotic history, and hospice care. The numerator looks for an antibiotic medication prescribed. Antibiotic medications for URI are defined by the codes in the value set 'Antibiotic Medications for Upper Respiratory Infection'. We will consider making updates in a future iteration of the measure. In the meantime, please share any specific use cases you may have.