Thank you for your inquiry regarding CMS996v5, Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED). The updated Version 6 (CMS996v6) STEMI measure specifications for the 2026 reporting period have denominator exceptions for ED encounters with a documented reason (such as not indicated) 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 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 ]. In v6, 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 PCI is not appropriate. 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.