Back to top
Top
U.S. flag

An official website of the United States government

Dot gov

Official websites use .gov
A .gov website belongs to an official government organization in the United States.

Https

Secure .gov websites use HTTPS
A lock ( ) or https:// means you’ve safely connected to the .gov website. Share sensitive information only on official, secure websites.

Complete both filters and then click Find an eCQM to see the top 10 results.

Appropriate Treatment for Upper Respiratory Infection (URI)

Receive updates on this topic

Measure Information 2022 Performance Period
CMS eCQM ID CMS154v10
NQF Number Not Applicable
MIPS Quality ID 065
Description

Percentage of episodes for patients 3 months of age and older with a diagnosis of upper respiratory infection (URI) that did not result in an antibiotic dispensing event.
Initial Population

Outpatient visits, telephone visits, online assessments (i.e. e-visit or virtual check-in), observation stays or emergency department visits with a diagnosis of URI during the measurement period among patients 3 months of age and older.
Numerator

URI episodes without a prescription for antibiotic medication on or 3 days after the outpatient visit, telephone visit, online assessment, observation stay or emergency department visit for an upper respiratory infection
Numerator Exclusions

Not Applicable
Denominator

Equals Initial Population
Denominator Exclusions

Exclude URI episodes when the patient had a comorbid condition during the 12 months prior to or on the episode date.

Exclude URI episodes when the patient had an active prescription of antibiotics in the 30 days prior to the episode date, including the episode date up until the time of the encounter.

Exclude URI episodes when the patient had competing diagnosis on or three days after the episode date.

Exclude URI episodes when the patient had hospice care for any part of the measurement period.
Denominator Exceptions

None
Steward National Committee for Quality Assurance
Measure Scoring Proportion measure
Measure Type Process measure
Improvement Notation

Higher score indicates better quality
Guidance

This is an episode of care measure that examines all eligible episodes for the patient during the measurement period.

This eCQM is an episode-based measure. An episode is defined as each eligible encounter for patients aged 3 months of age and older with a diagnosis of upper respiratory infection during the measurement period.

 

This version of the eCQM uses QDM version 5.5. Please refer to the eCQI resource center for more information on the QDM.
Telehealth Eligible Yes
Next Version
CMS154v11
Previous Version
CMS154v9

Compare eCQM Versions

The Compare function compares two years of the measure specifications found in the header of the measure's HTML. It does not include a comparison of any information in the body of the HTML, e.g., population criteria, Clinical Quality Language, or value sets.

Strikethrough text highlighted in red indicates information changed from the previous version. Text highlighted in green indicates information updated in the new eCQM version.

Filter Measure By
Download
Measure Information 2021 Performance Period 2022 Performance Period 2023 Performance Period 2024 Performance Period
Title Appropriate Treatment for Upper Respiratory Infection (URI) Appropriate Treatment for Upper Respiratory Infection (URI) Appropriate Treatment for Upper Respiratory Infection (URI) Appropriate Treatment for Upper Respiratory Infection (URI)
CMS eCQM ID CMS154v9 CMS154v10 CMS154v11 CMS154v12
NQF Number Not Applicable Not Applicable Not Applicable Not Applicable
Description

Percentage of episodes for patients 3 months of age and older with a diagnosis of upper respiratory infection (URI) that did not result in an antibiotic dispensing event.

Percentage of episodes for patients 3 months of age and older with a diagnosis of upper respiratory infection (URI) that did not result in an antibiotic dispensing event.

Percentage of episodes for patients 3 months of age and older with a diagnosis of upper respiratory infection (URI) that did not result in an antibiotic order

Percentage of episodes for patients 3 months of age and older with a diagnosis of upper respiratory infection (URI) that did not result in an antibiotic order
Initial Population

Outpatient visits, telephone visits, online assessments, observation stays or emergency department visits with a diagnosis of URI during the measurement period among patients 3 months of age and older.

Outpatient visits, telephone visits, online assessments (i.e. e-visit or virtual check-in), observation stays or emergency department visits with a diagnosis of URI during the measurement period among patients 3 months of age and older.

Outpatient visits, telephone visits, online assessments (i.e. e-visit or virtual check-in), observation stays or emergency department visits with a diagnosis of URI during the measurement period among patients 3 months of age and older

Outpatient visits, telephone visits, online assessments (i.e., e-visit or virtual check-in), observation stays or emergency department visits with a diagnosis of URI from January 1 to December 28 of the measurement period for patients 3 months of age and older
Denominator

Equals Initial Population

Equals Initial Population

Equals Initial Population

Equals Initial Population
Denominator Exclusions Exclude URI episodes when the patient had a competing comorbid condition during the 12 months prior to or on the episode date. Exclude URI episodes when the patient had a new or refill prescription of antibiotics in the 30 days prior to or on the episode date. Exclude URI episodes when the patient had competing diagnosis on or three days after the episode date. Exclude URI episodes when the patient had hospice care overlapping with the measurement period. Exclude URI episodes when the patient had a comorbid condition during the 12 months prior to or on the episode date. Exclude URI episodes when the patient had an active prescription of antibiotics in the 30 days prior to the episode date, including the episode date up until the time of the encounter. Exclude URI episodes when the patient had competing diagnosis on or three days after the episode date. Exclude URI episodes when the patient had hospice care for any part of the measurement period. Exclude URI episodes when the patient had a comorbid condition during the 12 months prior to or on the episode date. Exclude URI episodes when the patient had an active prescription of antibiotics in the 30 days prior to the episode date but is still active the same day of the encounter. Exclude URI episodes when the patient had competing diagnosis on or three days after the episode date. Exclude URI episodes when the patient had hospice care for any part of the measurement period. Exclude URI episodes when the patient had hospice care for any part of the measurement period.Exclude URI episodes when the patient had a comorbid condition during the 12 months prior to or on the episode date.Exclude URI episodes where the patient is taking antibiotics in the 30 days prior to the episode date.Exclude URI episodes where the patient had competing diagnosis on or three days after the episode date.
Numerator

URI episodes without a prescription for antibiotic medication on or 3 days after the outpatient visit, telephone visit, online assessment, observation stay or emergency department visit for an upper respiratory infection

URI episodes without a prescription for antibiotic medication on or 3 days after the outpatient visit, telephone visit, online assessment, observation stay or emergency department visit for an upper respiratory infection

URI episodes without a prescription for antibiotic medication on or 3 days after the outpatient visit, telephone visit, online assessment, observation stay or emergency department visit for an upper respiratory infection

URI episodes without a prescription for antibiotic medication on or three days after the outpatient visit, telephone visit, online assessment, observation stay or emergency department visit for an upper respiratory infection
Numerator Exclusions

Not Applicable

Not Applicable

Not Applicable

Not Applicable
Denominator Exceptions

None

None

None

None
Measure Steward National Committee for Quality Assurance National Committee for Quality Assurance National Committee for Quality Assurance National Committee for Quality Assurance
Measure Scoring Proportion measure Proportion measure Proportion measure Proportion measure
Measure Type Process measure Process measure Process measure Process measure
Improvement Notation

Higher score indicates better quality

Higher score indicates better quality

Higher score indicates better quality

Higher score indicates better quality
Guidance

This is an episode of care measure that examines all eligible episodes for the patient during the measurement period.

This eCQM is a episode-based measure.

 

This version of the eCQM uses QDM version 5.5. Please refer to the eCQI resource center for more information on the QDM.

This is an episode of care measure that examines all eligible episodes for the patient during the measurement period.

This eCQM is an episode-based measure. An episode is defined as each eligible encounter for patients aged 3 months of age and older with a diagnosis of upper respiratory infection during the measurement period.

 

This version of the eCQM uses QDM version 5.5. Please refer to the eCQI resource center for more information on the QDM.

This is an episode of care measure that examines all eligible episodes for the patient during the measurement period.

This eCQM is an episode-based measure. An episode is defined as each eligible encounter for patients aged 3 months of age and older with a diagnosis of upper respiratory infection during the measurement period.

 

This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM.

This is an episode of care measure that examines all eligible episodes for the patient.

This eCQM is an episode-based measure. An episode is defined as each eligible encounter for patients aged 3 months of age and older with a diagnosis of upper respiratory infection from January 1 to December 28 of the measurement period.

 

This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM.
MIPS Quality ID 065 065 065 065
Telehealth Eligible Yes Yes Yes Yes
Next Version CMS154v10 CMS154v11 CMS154v12 No Version Available
Previous Version No Version Available
CMS154v9
CMS154v10
CMS154v11
Notes
Download XML
Download CSV
Specifications
Attachment Size
CMS154v10.html 80.35 KB
CMS154v10.zip 80.67 KB
CMS154v10-TRN.xlsx 20.08 KB

Data Element Repository

Value Sets
Value Sets to be used with CMS154v10
CMS154v10-TRN.xlsx

Header

  • Updated the eCQM version number.

    Measure Section: eCQM Version Number

    Source of Change: Annual Update

  • Updated copyright.

    Measure Section: Copyright

    Source of Change: Annual Update

  • Updated the rationale to align with current evidence.

    Measure Section: Rationale

    Source of Change: Measure Lead

  • Updated references.

    Measure Section: Reference

    Source of Change: Annual Update

  • Updated the guidance to clarify the measure intent and support implementation.

    Measure Section: Guidance

    Source of Change: Measure Lead

  • Added clarifying language to guidance section of episode-based measures to define the episode.

    Measure Section: Guidance

    Source of Change: Measure Lead

  • Revised language in the inital population to reduce ambiguity and improve clarity.

    Measure Section: Initial Population

    Source of Change: Measure Lead

  • Replaced 'overlaps' or 'overlapping' in the denominator exclusions with plain language to clarify the measure intent.

    Measure Section: Denominator Exclusions

    Source of Change: Measure Lead

  • Revised the denominator exclusions language to reduce ambiguity in the exclusions.

    Measure Section: Denominator Exclusions

    Source of Change: Measure Lead

Logic

  • Harmonized the types of encounters considered denominator eligible to align with the measure intent and measures of similar type.

    Measure Section: Initial Population

    Source of Change: Measure Lead

  • Restructured the return on the Encounter with Competing Diagnosis for Upper Respiratory Infection definition to reduce confusion for implementers.

    Measure Section: Definitions

    Source of Change: Measure Lead

  • Revised the definitions to base timing of measure criteria on the time of the encounter to align with the measure intent to use encounter information to determine valid time intervals for conditions/medications.

    Measure Section: Definitions

    Source of Change: Measure Lead

  • Added online assessments as appropriate encounters based on the increased use of telehealth services.

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

  • Updated Hospice CQL Library to version 3.0.000.

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

  • Updated the version number of the Measure Authoring Tool (MAT) Global Common Functions Library (MATGlobalCommonFunctions-6.2.000). Updated the 'Inpatient Encounter' definition to include a 'day of' timing clarification. Added the following timing functions: Normalize Interval, Has Start, Has End, Latest, Latest Of, Earliest, and Earliest Of. Please see individual measure details for application of specific timing functions.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Added new NormalizeInterval function to timing attributes to decrease implementation burden due to variable use of timing attributes for select QDM data types. The NormalizeInterval function was applied, where applicable, for the following data elements: Assessment, Performed; Device, Applied; Diagnostic Study, Performed; Intervention, Performed; Laboratory Test, Performed; Medication, Administered; Medication, Dispensed; Physical Exam, Performed; Procedure, Performed; Substance, Administered.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

Value Set

The VSAC is the source of truth for the value set content, please visit the VSAC for downloads of current value sets.

  • Value set Antibiotic Medications for Pharyngitis (2.16.840.1.113883.3.464.1003.196.12.1001): Added 2 RxNorm codes (2387078, 2387079) based on terminology update. Deleted 24 RxNorm codes based on terminology update.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Competing Conditions for Respiratory Conditions (2.16.840.1.113883.3.464.1003.102.12.1017): Added 1269 SNOMED CT codes based on review by technical experts, SMEs, and/or public feedback or based on terminology update. Deleted 1159 SNOMED CT codes based on review by technical experts, SMEs, and/or public feedback. Added 5 ICD-10-CM codes (B60.00, B60.01, B60.02, B60.03, B60.09) based on review by technical experts, SMEs, and/or public feedback. Deleted 37 ICD-10-CM codes based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Telephone Visits (2.16.840.1.113883.3.464.1003.101.12.1080): Added 5 SNOMED CT codes (185317003, 314849005, 386472008, 386473003, 401267002) based on change in measure requirements/measure specification.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Comorbid Conditions for Respiratory Conditions (2.16.840.1.113883.3.464.1003.102.12.1025): Added 9 SNOMED CT codes (22607003, 266355005, 307202004, 74610006, 76157009, 782761005, 789056000, 789057009, 860803004) based on updated evidence in published guidelines, published literature, or from published specialty medical society or group recommendations. Added 14 ICD-10-CM codes based on updated evidence in published guidelines, published literature, or from published specialty medical society or group recommendations.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added value set Medical Disability Exam (2.16.840.1.113883.3.464.1003.101.12.1073) based on change in measure requirements/measure specification.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added value set Home Healthcare Services (2.16.840.1.113883.3.464.1003.101.12.1016) based on change in measure requirements/measure specification.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added value set Preventive Care Services-Individual Counseling (2.16.840.1.113883.3.464.1003.101.12.1026) based on change in measure requirements/measure specification.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added value set Preventive Care Services - Group Counseling (2.16.840.1.113883.3.464.1003.101.12.1027) based on change in measure requirements/measure specification.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added value set Observation (2.16.840.1.113883.3.464.1003.101.12.1086) based on change in measure requirements/measure specification.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added value set Online Assessments (2.16.840.1.113883.3.464.1003.101.12.1089) based on change in measure requirements/measure specification.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added direct reference code CPT code (99217) based on change in measure requirements/measure specification.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added value set Outpatient Consultation (2.16.840.1.113883.3.464.1003.101.12.1008) based on change in measure requirements/measure specification.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added value set Preventive Care Services - Other (2.16.840.1.113883.3.464.1003.101.12.1030) based on based on change in measure requirements/measure specification.

    Measure Section: Terminology

    Source of Change: Measure Lead

Last Updated: Apr 24, 2023