Thank you for inquiring about the Preventive Care and Screening: Screening for Depression and Follow-Up Plan eCQM. Please note that the measure uses a direct reference code in the Terminology section for "Depression screening declined (situation)." The relevant code is SNOMED-CT code 720834000. This code was intentionally used as a direct reference code rather than using the Patient Reason value set, as it is specific to the context of the measure (declining depression screenings). Additional context on direct reference codes can be found in the Guide for Reading Electronic Clinical Quality Measures https://ecqi.healthit.gov/sites/default/files/2025-Guide-for-Reading-eCQMs.pdf (version 10 for the CMS2v14 measure referenced). "If a single code—rather than a collection of codes in a value set—can define a clinical or administrative concept, then there is an alternative method for associating the concept to the QDM data element. Instead of creating a single-code value set, the eCQM expression directly embeds the code into the CQL logic statements."