Thank you for your inquiry about CMS122v14 (2026 Performance Period). The intent of the measure is to look for a patient's most recent HbA1c level to be greater than 9.0%, is missing, or was not performed during the measurement period. The current logic looks for the latest HbA1c Laboratory Test performed during the measurement period. In your example, if a patient has an HbA1c with a null value and a result that is less than 9% on the same day, the most recent lab test datetime will be pulled into the measure. If you have questions about reading the measure specification or understanding data 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 .