Thank you for your inquiry regarding CMS131v14 (2026 Performance Period). The measure looks for diabetic patients aged 18-75 who had an outpatient visit during the measurement period and received a retinal or dilated eye exam, based on whether they had retinopathy diagnosed during the period or within the previous year. Documentation should include exam details, date, results, and confirmation by an ophthalmologist or optometrist. Exams conducted externally must be recorded in the EHR using a SNOMEDCT code from the "Retinal or Dilated Eye Exam" value set. However, external results not documented in the EHR will not satisfy the measure criteria, regardless of where the exams were performed. The logic is specified such that if the providers are sharing an EHR or if data is being shared through Health Information Exchange, all providers that have access to the data would receive credit. To fulfill the criteria for this measure, ensure documentation aligns with the measure requirements and is recorded within the EHR. If you need assistance reading an eCQM, please refer to the resources available at eCQI Resource Center, such as "Guide for Reading eCQMs" or "Implementation Checklist eCQM Annual Update": 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 .

We are working with ophthalmology practices that includes multiple subspecialties (e.g., cornea/anterior segment, oculoplastics, etc.). We have encountered a recurring scenario in which patients with diabetes are seen during the measurement period by a corneal or anterior segment specialist for management of a condition unrelated to diabetes/diabetic retinopathy. In many cases, these providers appropriately do not perform a dilated retinal examination because the patient is already receiving their annual diabetic retinal examination from an external ophthalmologist or optometrist who referred the patient. The treating provider (in question) documents that the patient is receiving diabetic eye care from the external eye care professional and references that the retinal or dilated examination has been completed externally. However, because the current measure specifications require documentation of a qualifying retinal or dilated eye examination, these encounters do not receive numerator credit unless the actual exam findings or qualifying data elements from the external examination are documented in a manner that satisfies the eCQM logic. As a result, providers who appropriately defer the diabetic retinal examination to the patient's established eye care provider are negatively impacted in performance reporting.