Thank you for your inquiry regarding CMS996v6, Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED). The updated Version 6 STEMI measure specifications for the 2026 reporting period include denominator exceptions for ED encounters with a documented reason for either (1) not administering fibrinolytic therapy within 30 minutes of ED arrival or (2) not performing a percutaneous coronary intervention (PCI) within 90 minutes of ED arrival, as reflected in the measure logic below, found in the measure’s HTML file posted on the eCQI Resource Center [ https://ecqi.healthit.gov/sites/default/files/ecqm/measures/CMS996-v6.3.000-QDM.html ]. Denominator Exceptions   "Received TPA In Another Facility Within 24 hours Prior To Admission"     union "ED Encounter With A Documented Reason For No PCI Performed Within 90 Minutes Of ED Arrival"     union "ED Encounter With A Documented Reason For Not Administering Fibrinolytic Therapy Within 30 Minutes Of ED Arrival" The “union” in the measure logic indicates that ED encounters meeting any of the three criteria qualify as denominator exceptions. In other words, ED encounters with a documented reason for not performing a PCI within 90 minutes of ED arrival meet the denominator exception criteria and do not require a documented reason for not administering fibrinolytic therapy. Please note that, unlike denominator exclusions, denominator exceptions are removed from the denominator only when the numerator is not met. Providers are not penalized for failing to meet the numerator requirements (i.e., administration of fibrinolytic therapy within 30 minutes of ED arrival, PCI within 90 minutes of ED arrival, or discharge to acute care within 45 minutes of ED arrival). Reasons for not administering fibrinolytic therapy are captured using the “Medication, Not Administered” data type in conjunction 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. Similarly, 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 can be accessed through the Value Set Authority Center (VSAC) by searching each value set’s OID at https://vsac.nlm.nih.gov/welcome . Please note that a free account may be required to view the codes.