Thank you for your inquiry about CMS138v13 (performance period 2025). 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).The current measure does not include patient reasons for declining tobacco cessation intervention as it does not meet the clinical intent of the measure. 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. Clinically equivalent services can be mapped to the codes; if mapping is done, you should maintain documentation in case of a CMS audit. 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?qt-tabs_ep=ecqm-resources&global_measure_group=eCQMs