Thank you for your inquiry about CMS138v13 (2025 performance period). The USPSTF references the U.S. Food and Drug Administration’s definition of tobacco, which includes e cigarettes, hookah pens, and other electronic nicotine delivery systems. E cigarettes and vaping products typically contain nicotine, the addictive ingredient in tobacco. However, they are not always classified as “smokeless tobacco,” since these devices can also be used with substances other than tobacco. Non nicotine, non tobacco substance use is not included in this measure. Therefore, in your example, individuals who screen positive for CBD/THC use but negative for tobacco use would not be classified as tobacco users. We are unable to provide guidance on how these events should be documented in the EHR. We recommend consulting your EHR vendor and clinical partners for documentation practices. If you have questions about understanding measure 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 .