Thank you for your inquiry regarding CMS122v13 (2025 Performance Period). This measure's denominator looks for patients who have both a qualifying encounter and an active diabetes diagnosis, identified using a code from the "Diabetes" value set (2.16.840.1.113883.3.464.1003.103.12.1001), during the measurement period. The measure logic specifies that the diabetes diagnosis must overlap the measurement period to qualify for the initial population. Although diabetes is a chronic condition that typically persists over time, the logic requires that they be active during the measurement period. A diabetes diagnosis that began prior to the measurement period should still be considered active, as these conditions typically do not resolve. Thus, patients with these diagnoses, even if documented before the measurement year, should be counted since these conditions do not have an end date, ensuring overlap with the measurement period. However, if the diagnosis onset and abatement dates fall entirely outside of the measurement period, the patient would not meet the criteria. We are unable to provide guidance on how these events should be documented in the EHR. We recommend you consult with your EHR vendor and clinical partners. 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/ecqm-resources?globalyearfilter=2025&global_measure_group=3716