117 / CMS131

XMLWordPrintable

    • Type: EC eCQMs - Eligible Clinicians
    • Resolution: Answered
    • Priority: Moderate
    • Component/s: None
    • None
    • Michelle Bowes
    • 4027709875
    • Mavin Healthcare Experts
    • Hide
      Thank you for your question regarding CMS131v14 (2026 Performance Period). Self-reported screenings are accepted if they are documented using a SNOMEDCT code from the "Retinal or Dilated Eye Exam" value set. The documentation must include evidence of the retinal or dilated eye exam, the date of the exam, and the result. The documentation must also include evidence that the exam was performed by an eye care professional or interpreted by a system that provides an artificial intelligence (AI) interpretation.

      The measure does not prescribe how this information should be documented in structured fields of EHRs. 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. For inquiries about CMS quality program reporting requirements or other quality measure collection types (e.g., MIPS CQM), please contact the QPP Helpdesk at QPP@cms.hhs.gov.
      Show
      Thank you for your question regarding CMS131v14 (2026 Performance Period). Self-reported screenings are accepted if they are documented using a SNOMEDCT code from the "Retinal or Dilated Eye Exam" value set. The documentation must include evidence of the retinal or dilated eye exam, the date of the exam, and the result. The documentation must also include evidence that the exam was performed by an eye care professional or interpreted by a system that provides an artificial intelligence (AI) interpretation. The measure does not prescribe how this information should be documented in structured fields of EHRs. 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 . For inquiries about CMS quality program reporting requirements or other quality measure collection types (e.g., MIPS CQM), please contact the QPP Helpdesk at QPP@cms.hhs.gov .
    • CMS0131v14
    • Primary Care wants to be able to utilize the measure for diabetic care and eCQM performance under QPP.

      Measure states that one option for increasing the numerator is an eye exam performed by an ophthalmologist or optometrist. We have Primary Care clinicians who manage diabetic patients and who are monitoring this measure closely for other payer quality programs. The measure details lead us to believe that the exam could be a patient-reported, with a qualifying date, and documented by the PCP. However, the value set 2.16.840.1.113883.3.464.1003.115.12.1088 includes only procedural codes (limiting documentation to only include administration of the eye exam).

      Often retinal exams are not returned to the Primary Care, who manage diabetic care, and are self reported by the patient. This measure gives Primary Care the opportunity to document it if, and when, a patient receives the exam.

      I see there is a "yes" SNOMED 373066001. Can this, along with a date of exam, be used to increment the numerator? And if not, we'd formally like to request a way for Primary Care to utilize this measure in future versions.

            Assignee:
            AIR EC eCQM Team
            Reporter:
            MICHELLE BOWES
            Votes:
            0 Vote for this issue
            Watchers:
            2 Start watching this issue

              Created:
              Updated:
              Resolved:
              Solution Posted On: