1. This is a patient-based measure, reported once per measurement period for patients that have a qualifying encounter. The value set "Encounter to Evaluate BMI" (2.16.840.1.113883.3.600.1.1751) provides the qualifying encounters, the details of the encounter types can be found at the Value Set Authority Center. You may need to confer with your measure reporting vendor to confirm whether nurse visits are mapped to any codes within the value set. If a BMI is documented in the record at any time during the measurement period and there is a qualifying encounter, then the BMI will be used in the measure performance evaluation. The measure’s Guidance section indicates that "The BMI may be documented in the medical record of the provider or in outside medical records obtained by the provider.” Many providers opt to obtain measurements for their patients at every encounter to ensure that they accurately report performance. 2.See below:      a. The “Definitions” section of the measure logic shows: Normal is between 18.5 to <25 kg/m2; High >/= 25 kg/m2; Low <18.5 kg/m2           i. Documented High BMI during Measurement Period                a. "BMI during Measurement Period" BMI                     i. where Global."NormalizeInterval" ( BMI.relevantDatetime, BMI.relevantPeriod ) during day of "Measurement Period"                     ii. and BMI.result >= 25 'kg/m2'           ii. Documented Low BMI during Measurement Period                a. "BMI during Measurement Period" BMI                     i. where Global."NormalizeInterval" ( BMI.relevantDatetime, BMI.relevantPeriod ) during day of "Measurement Period"                     ii. and BMI.result < 18.5 'kg/m2'           iii. Has Normal BMI                a. exists ( "BMI during Measurement Period" BMI                     i. where BMI.result >= 18.5 'kg/m2'                     ii. and BMI.result < 25 'kg/m2'                b.)                     i. and not ( exists "Documented High BMI during Measurement Period"                     ii. or exists "Documented Low BMI during Measurement Period"                     iii. )      b. Review the VSAC valuesets "Follow Up for Above Normal BMI" (2.16.840.1.113883.3.600.1.1525), and "Follow Up for Below Normal BMI" (2.16.840.1.113883.3.600.1.1528) for allowable follow-up actions and associated codes, which "must be based on the documented BMI, outside of normal parameters, example: "Patient referred to nutrition counseling for BMI above or below normal parameters.”” (Guidance section). Per the Definition section of the measure, "A follow-up plan may include, but is not limited to: documentation of education, referral (for example a registered dietitian nutritionist, occupational therapist, physical therapist, primary care provider, exercise physiologist, mental health professional, or surgeon) for lifestyle/behavioral therapy, pharmacological interventions, dietary supplements, exercise counseling and/or nutrition counseling.”      c. CMS does not provide workflow implementation recommendations. If your proposed workflow aligns with the measure guidance for high/low/normal BMI and when follow-up is required, then you will not adversely impact performance.      d. The measure is only for patients ages 18 or older on the date of the first qualifying encounter during the measurement period. Therefore, if your pediatric patient population includes 18 to 21-year-olds, then that subset can be reported for the measure.