CMS 69 BMI 12 month look-back period

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    • Type: EC eCQMs - Eligible Clinicians
    • Resolution: Answered
    • Priority: Moderate
    • Component/s: None
    • None
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      Thank you for inquiring about CMS0069v14 (Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan).
       
      Please note that, with eCQMs, the measure description provides only a high-level overview of the measure’s intent. The logic must be reviewed to understand the nuances. In this case, both the BMI screening and intervention must both occur during the measurement period—there is no look-back period in the eCQM. CQM and eCQM measure versions will not always align as they utilize different data sources, abstraction methods and the specifications are designed for distinct workflows. For specific questions about the CQM specification, please reach out to QPP Helpdesk at QPP@cms.hhs.gov.
       
      Refer to measure logic excerpts from CMS0069v14 below:
       
      Documented High BMI During Measurement Period
      o "BMI During Measurement Period" BMI
      o where Global."NormalizeInterval" ( BMI.relevantDatetime, BMI.relevantPeriod ) during day of "Measurement Period"
      o and BMI.result >= 25 'kg/m2'
      High BMI And Follow Up Provided
      o ( "Documented High BMI During Measurement Period" HighBMI
      o with ( "High BMI Interventions Ordered"
      o union "High BMI Interventions Performed" ) HighBMIInterventions
      o such that ( Coalesce(start of Global."NormalizeInterval"(HighBMIInterventions.relevantDatetime, HighBMIInterventions.relevantPeriod), HighBMIInterventions.authorDatetime) during day of "Measurement Period" )
       
      Show
      Thank you for inquiring about CMS0069v14 (Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan).   Please note that, with eCQMs, the measure description provides only a high-level overview of the measure’s intent. The logic must be reviewed to understand the nuances. In this case, both the BMI screening and intervention must both occur during the measurement period—there is no look-back period in the eCQM. CQM and eCQM measure versions will not always align as they utilize different data sources, abstraction methods and the specifications are designed for distinct workflows. For specific questions about the CQM specification, please reach out to QPP Helpdesk at QPP@cms.hhs.gov .   Refer to measure logic excerpts from CMS0069v14 below:   Documented High BMI During Measurement Period o "BMI During Measurement Period" BMI o where Global."NormalizeInterval" ( BMI.relevantDatetime, BMI.relevantPeriod ) during day of "Measurement Period" o and BMI.result >= 25 'kg/m2' High BMI And Follow Up Provided o ( "Documented High BMI During Measurement Period" HighBMI o with ( "High BMI Interventions Ordered" o union "High BMI Interventions Performed" ) HighBMIInterventions o such that ( Coalesce(start of Global."NormalizeInterval"(HighBMIInterventions.relevantDatetime, HighBMIInterventions.relevantPeriod), HighBMIInterventions.authorDatetime) during day of "Measurement Period" )  
    • CMS0069v14
    • Our network is unsure if we are properly capturing the measure as required.

      Our network intends to submit CMS 69 (BMI Screening and Follow-Up Plan) for the 2026 performance year and has received questions regarding the applicable timing requirements for this measure.

      The technical specifications indicate that BMI must be documented and addressed, if clinically indicated, within the measurement period. However, certain specifications reference a 12-month look-back period. Additionally, we note differences in wording between the CQM and eCQM numerator descriptions, which has created confusion among our providers.

      For example:

      CQM Numerator (QPP specification):
      Patients with a documented BMI during the encounter or within the previous 12 months, AND if the BMI is outside normal parameters, a follow-up plan documented during the encounter or within the previous 12 months.

      eCQM Numerator (eCQI specification):
      Patients aged 18 years and older with a BMI documented during the current encounter or during the measurement period AND a follow-up plan documented if BMI is outside normal parameters.

      We are seeking clarification on the following:

      For patients with an encounter during the 2026 measurement period (January 1, 2026 – December 31, 2026), does the 12-month look-back period apply to BMI documentation and follow-up plan requirements, or must both occur strictly within the 2026 measurement period?

            Assignee:
            AIR EC eCQM Team
            Reporter:
            Summer Hall
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              Created:
              Updated:
              Resolved:
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