Thank you for your inquiry regarding CMS0149v14 (Dementia: Cognitive Assessment). The measure definition states that “Cognition can be assessed by the clinician during the patient's clinical history. Cognition can also be assessed by direct examination of the patient using one of a number of instruments, including several originally developed and validated for screening purposes. This can also include, where appropriate, administration to a knowledgeable informant.” The measure logic definition for “standardized tools or alternate methods” uses the "Cognitive Assessment" (2.16.840.1.113883.3.526.3.1332) and "Standardized Tools Score for Assessment of Cognition" (2.16.840.1.113883.3.526.3.1006) value sets. Please refer to these value sets for assessments that will count towards the measure numerator. A full list of value sets used in the measure can be found here: https://vsac.nlm.nih.gov/valueset/expansions?pr=ecqm&rel=eCQM%20Update%202025-05-08&q=CMS149v14 . While the measure logic does not prohibit ED, hospital or procedures visits, according to the measure steward (the American Academy of Neurology), these settings are not ideal settings for assessing cognition as patients in medical duress frequently have worse cognition due to superimposed things like delirium. Additionally, during procedure visits, patients do not typically undergo cognitive tests before anesthesia. Please refer to the current Performance Year 2026 measure specifications to ensure you are following the requirements and understand the allowable methods. You can find the current those specifications here: https://ecqi.healthit.gov/sites/default/files/ecqm/measures/CMS149-v14.0.000-QDM.html .