Thank you for your inquiry regarding CMS996: Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED). The updated STEMI measure specification for the 2026 reporting period (CMS996v6) includes denominator exceptions for ED encounters with a documented reason (such as patient 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. ED encounters with a documented reason for not administering fibrinolytic therapy or not performing a PCI within the above-mentioned timeframes are still included in the measure; however, providers are not penalized for not meeting the numerator requirements. The updated measure specifications are available in the eCQI Resource Center: [ https://ecqi.healthit.gov/ecqm/hosp-outpt/2026/cms0996v6?qt-tabs_measure=measure-information ]. Reasons for not administering fibrinolytic therapy are captured using the “Medication, Not Administered” data type together with the “Patient Refusal” (OID: 2.16.840.1.113883.3.117.1.7.1.93) and “Drug Intervention Not Indicated/Contraindicated” (OID: 2.16.840.1.113762.1.4.1282.1) value sets. 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 value sets cover scenarios where a patient refuses treatment or opts for medical management, and recommendations regarding consent or procedural indications. 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.