Thank you for your feedback for CMS996: Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED). In response to provider feedback, the updated Version 6 STEMI measure specifications for the 2026 reporting period have denominator exceptions for ED encounters with a documented reason (such as family refusal) for (i) not administering fibrinolytic therapy within 30 minutes of ED arrival or (ii) not performing a PCI within 90 minutes of ED arrival. Additionally, the updated measure specifications exclude patients from the measure denominator who have documentation of hospice services in the six months within the start of the ED encounter, or who have active hospice status at the start of the ED encounter. Please note that, unlike denominator exclusions, denominator exceptions are still included in the measure; however, providers are not penalized for not meeting the numerator requirements. Reasons for not performing a PCI are captured using the “Procedure, Not Performed” data type together with the “Patient Refusal” (OID: 2.16.840.1.113883.3.117.1.7.1.93) and “Procedure Not Indicated/Contraindicated" (OID: 2.16.840.1.113762.1.4.1282.2) value sets. The “Patient Refusal” value set covers the scenarios where the patient and family refuse PCI, or if the patient has a comfort care order and is not receiving hospice care. These value sets can be found in the Value Set Authority Center (VSAC) by searching each value set’s OID [ https://vsac.nlm.nih.gov/welcome ]. Please note that you may need to create a free account to view these codes.