Thank you for your inquiry about CMS138v13 (2025 performance period). Please note that the measure logic does not require tobacco use screenings to be tied to a specific encounter. This measure identifies a tobacco screening via QDM datatype "Assessment, Performed" along with the value set "Tobacco Use Screening", and identifies a result using the QDM attribute "result". The "result" attribute must be identified as either "Tobacco Non-User" or "Tobacco User". Patient reported responses may be used to satisfy the tobacco screening given the information mentioned above is documented in a structured field in an EHR. 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 . For additional guidance regarding MIPS eligibility and participation options, you may submit questions to the QPP helpdesk.