CMS131 Diabetes Eye Exam- what constitutes an eye exam

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    • Type: EC eCQMs - Eligible Clinicians
    • Resolution: Answered
    • Priority: Moderate
    • Component/s: None
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      Thank you for your question regarding CMS131v13 (2025 Performance Period). To meet the numerator requirements for this measure, patients must have had an eye screening for diabetic retinal disease. Eye exams are accepted if they are documented in the EHR using a code from the "Retinal or Dilated Eye Exam" value set (2.16.840.1.113883.3.464.1003.115.12.1088). The EHR must reflect evidence of the retinal or dilated eye exam including the date of the exam and the result. The documentation must also include evidence that the exam was performed by an eye care professional. As stated in the guidance section of the measure specification: “The eye exam must be performed by an ophthalmologist or optometrist, or there must be evidence that fundus photography results were read by a system that provides an artificial intelligence (AI) interpretation.” For additional information on eCQM specifications, please refer to the eCQI resource center at https://ecqi.healthit.gov/ep-ec?qt-tabs_ep=0.
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      Thank you for your question regarding CMS131v13 (2025 Performance Period). To meet the numerator requirements for this measure, patients must have had an eye screening for diabetic retinal disease. Eye exams are accepted if they are documented in the EHR using a code from the "Retinal or Dilated Eye Exam" value set (2.16.840.1.113883.3.464.1003.115.12.1088). The EHR must reflect evidence of the retinal or dilated eye exam including the date of the exam and the result. The documentation must also include evidence that the exam was performed by an eye care professional. As stated in the guidance section of the measure specification: “The eye exam must be performed by an ophthalmologist or optometrist, or there must be evidence that fundus photography results were read by a system that provides an artificial intelligence (AI) interpretation.” For additional information on eCQM specifications, please refer to the eCQI resource center at https://ecqi.healthit.gov/ep-ec?qt-tabs_ep=0 .
    • CMS0131v13

      What type of eye exam should qualify a patient for the numerator of the measure? If a RetinaVue image is completed in a primary care office and read by an ophthalmologist, is this considered a retinal exam? Or must the patient be seen by an eye care professional for a full eye exam to be considered eligible for the numerator?

            Assignee:
            AIR EC eCQM Team
            Reporter:
            Jessica Cooper (Inactive)
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