Thank you for your inquiry about CMS138v14 (performance period 2026). The measure identifies 3 populations. Numerator 1 looks for screening completed. Numerator 2 and Numerator 3 look for tobacco cessation interventions if the screening is positive. One way of meeting tobacco cessation intervention is through documentation of an "Intervention, Performed" using any codes from the value set "Tobacco Use Cessation Counseling" (2.16.840.1.113883.3.526.3.509). Concepts such as written self-help materials (e.g., brochures, pamphlets) and complementary/alternative are not included in the value set and do not qualify for the numerator on their own. Education pamphlets may qualify if they are included in addition to the tobacco counseling; the intent is that education be provided via two-way interaction between the patient and provider. Providing the patient written materials without one of the intervention types found within the "Tobacco Use Cessation Counseling" (2.16.840.1.113883.3.526.3.509) value set does not fulfill the numerator criteria for either 'Population 2' or 'Population 3', for this measure.