Thank you for your inquiry regarding CMS129v13:Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients. The SNOMEDCT staging codes you referenced are identified as a direct reference codes in the measure logic to define the Prostate Cancer Staging Tumor Size T1a to T2a in the denominator. The eCQI Resource Center defines direct reference codes as specific codes referenced directly in the eCQM measure logic to describe a data element or one of its attributes. It is the intention of the measure logic to use the presence of only one code for each of the prostate cancer staging tumor sizes T1a to T2a . Therefore, these codes are not included in one of the measure’s value sets in VSAC. The codes can be identified in the terminology section of the measure specification. Please see the SNOMEDCT coding you requested below: Terminology ( https://ecqi.healthit.gov/sites/default/files/ecqm/measures/CMS129v13.html#toc ) • code "Neoplasm of prostate primary tumor staging category T1c: Tumor identified by needle biopsy (finding)" ("SNOMEDCT Code (433351000124101)") • code "Neoplasm of prostate primary tumor staging category T2a: Involves one-half of one lobe or less (finding)" ("SNOMEDCT Code (433361000124104)") • code "T1a: Prostate tumor incidental histologic finding in 5 percent or less of tissue resected (finding)" ("SNOMEDCT Code (369833007)") • code "T1b: Prostate tumor incidental histologic finding in greater than 5 percent of tissue resected (finding)" ("SNOMEDCT Code (369834001)")”