Use of High-Risk Medications in Older Adults

Measure Information	2022 Performance Period
CMS eCQM ID	CMS156v10
NQF Number	Not Applicable
Description	Percentage of patients 65 years of age and older who were ordered at least two high-risk medications from the same drug class. Three rates are reported. 1. Percentage of patients 65 years of age and older who were ordered at least two high-risk medications from the same drug class. 2. Percentage of patients 65 years of age and older who were ordered at least two high-risk medications from the same drug class, except for appropriate diagnoses. 3. Total rate (the sum of the two numerators divided by the denominator, deduplicating for patients in both numerators).
Initial Population	Patients 65 years and older who had a visit during the measurement period
Denominator	Equals Initial Population
Denominator Exclusions	Exclude patients who are in hospice care for any part of the measurement period. Exclude patients receiving palliative care during the measurement period.
Numerator	Rate 1 : Patients with at least two orders of high-risk medications from the same drug class. Rate 2: Patients with at least two orders of high-risk medications from the same drug class (i.e., antipsychotics and benzodiazepines). Total rate (the sum of the two previous numerators, deduplicated).
Numerator Exclusions	Rate 2: For patients with two or more antipsychotic prescriptions ordered, exclude patients who have a diagnosis of schizophrenia, schizoaffective disorder, or bipolar disorder on or between January 1 of the year prior to the measurement period and the Index Prescription Start Date (IPSD) for antipsychotics. For patients with two or more benzodiazepine prescriptions ordered, exclude patients who have a diagnosis of seizure disorders, rapid eye movement sleep behavior disorder, benzodiazepine withdrawal, ethanol withdrawal, or severe generalized anxiety disorder on or between January 1 of the year prior to the measurement period and the IPSD for benzodiazepines.
Denominator Exceptions	None
Measure Steward	National Committee for Quality Assurance
Measure Scoring	Proportion measure
Measure Type	Process measure
Improvement Notation	Lower score indicates better quality
Guidance	The intent of the measure is to assess if the patient has been ordered at least two of the same high-risk medication prescriptions from the same medication class on different days. The intent of the measure is to assess if the reporting provider ordered the high-risk medication(s). If the patient had a high-risk medication previously prescribed by another provider, they would not be counted towards the numerator unless the reporting provider also ordered a high-risk medication for them. This eCQM is a patient-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.
MIPS Quality ID	238
Telehealth Eligible	Yes
Next Version	CMS156v11
Previous Version	CMS156v9

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Measure Information	2021 Performance Period	2022 Performance Period	2023 Performance Period
Title	Use of High-Risk Medications in Older Adults	Use of High-Risk Medications in Older Adults	Use of High-Risk Medications in Older Adults
CMS eCQM ID	CMS156v9	CMS156v10	CMS156v11
NQF Number	Not Applicable	Not Applicable	Not Applicable
Description	Percentage of patients 65 years of age and older who were ordered at least two of the same high-risk medications.	Percentage of patients 65 years of age and older who were ordered at least two high-risk medications from the same drug class. Three rates are reported. 1. Percentage of patients 65 years of age and older who were ordered at least two high-risk medications from the same drug class. 2. Percentage of patients 65 years of age and older who were ordered at least two high-risk medications from the same drug class, except for appropriate diagnoses. 3. Total rate (the sum of the two numerators divided by the denominator, deduplicating for patients in both numerators).	Percentage of patients 65 years of age and older who were ordered at least two high-risk medications from the same drug class. Three rates are reported. 1. Percentage of patients 65 years of age and older who were ordered at least two high-risk medications from the same drug class. 2. Percentage of patients 65 years of age and older who were ordered at least two high-risk medications from the same drug class, except for appropriate diagnoses. 3. Total rate (the sum of the two numerators divided by the denominator, deduplicating for patients in both numerators).
Initial Population	Patients 65 years and older who had a visit during the measurement period	Patients 65 years and older who had a visit during the measurement period	Patients 65 years and older at the end of the measurement period who had a visit during the measurement period
Denominator	Equals Initial Population	Equals Initial Population	Equals Initial Population
Denominator Exclusions	Exclude patients whose hospice care overlaps the measurement period	Exclude patients who are in hospice care for any part of the measurement period. Exclude patients receiving palliative care during the measurement period.	Exclude patients who are in hospice care for any part of the measurement period. Exclude patients receiving palliative care for any part of the measurement period.
Numerator	Patients with at least two orders for the same high-risk medication on different days during the measurement period	Rate 1 : Patients with at least two orders of high-risk medications from the same drug class. Rate 2: Patients with at least two orders of high-risk medications from the same drug class (i.e., antipsychotics and benzodiazepines). Total rate (the sum of the two previous numerators, deduplicated).	Rate 1: Patients with at least two orders of high-risk medications from the same drug class on different days. a. At least two orders of high-risk medications from the same drug class. b. At least two orders of high-risk medications from the same drug class with summed days supply greater than 90 days. c. At least two orders of high-risk medications from the same drug class each exceeding average daily dose criteria. Rate 2: Patients with at least two orders of high-risk medications from the same drug class (i.e., antipsychotics and benzodiazepines) on different days. Total rate (the sum of the two previous numerators, deduplicated).
Numerator Exclusions	Not Applicable	Rate 2: For patients with two or more antipsychotic prescriptions ordered, exclude patients who have a diagnosis of schizophrenia, schizoaffective disorder, or bipolar disorder on or between January 1 of the year prior to the measurement period and the Index Prescription Start Date (IPSD) for antipsychotics. For patients with two or more benzodiazepine prescriptions ordered, exclude patients who have a diagnosis of seizure disorders, rapid eye movement sleep behavior disorder, benzodiazepine withdrawal, ethanol withdrawal, or severe generalized anxiety disorder on or between January 1 of the year prior to the measurement period and the IPSD for benzodiazepines.	Rate 2: For patients with two or more antipsychotic prescriptions ordered, exclude patients who have a diagnosis of schizophrenia, schizoaffective disorder, or bipolar disorder on or between January 1 of the year prior to the measurement period and the IPSD for antipsychotics. For patients with two or more benzodiazepine prescriptions ordered, exclude patients who have a diagnosis of seizure disorders, rapid eye movement sleep behavior disorder, benzodiazepine withdrawal, ethanol withdrawal, or severe generalized anxiety disorder on or between January 1 of the year prior to the measurement period and the IPSD for benzodiazepines.
Denominator Exceptions	None	None	None
Measure Steward	National Committee for Quality Assurance	National Committee for Quality Assurance	National Committee for Quality Assurance
Measure Scoring	Proportion measure	Proportion measure	Proportion measure
Measure Type	Process measure	Process measure	Process measure
Improvement Notation	Lower score indicates better quality	Lower score indicates better quality	Lower score indicates better quality
Guidance	The intent of the measure is to assess if the patient has been prescribed at least two of the same high-risk medications on different days. The intent of the measure is to assess if the reporting provider ordered the high-risk medication(s). If the patient had a high-risk medication previously prescribed by another provider, they would not be counted towards the numerator unless the reporting provider also ordered a high-risk medication for them. This eCQM is a patient-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.	The intent of the measure is to assess if the patient has been ordered at least two of the same high-risk medication prescriptions from the same medication class on different days. The intent of the measure is to assess if the reporting provider ordered the high-risk medication(s). If the patient had a high-risk medication previously prescribed by another provider, they would not be counted towards the numerator unless the reporting provider also ordered a high-risk medication for them. This eCQM is a patient-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.	The intent of the measure is to assess if the patient has been ordered at least two high-risk medication prescriptions from the same drug class on different days. The intent of the measure is to assess if the reporting provider ordered the high-risk medication(s). If the patient had a high-risk medication previously prescribed by another provider, they would not be counted towards the numerator unless the reporting provider also ordered a high-risk medication from the same drug class for them. Calculate average daily dose for each prescription event. To calculate average daily dose, multiply the quantity of pills prescribed by the dose of each pill and divide by the days supply. For example, a prescription for the 30-days supply of digoxin containing 15 pills, 0.25 mg each pill, has an average daily dose of 0.125 mg. To calculate average daily dose for elixirs and concentrates, multiply the volume prescribed by daily dose and divide by the days supply. Do not round when calculating average daily dose. This eCQM is a patient-based measure. 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	238	238	238
Telehealth Eligible	Yes	Yes	Yes
Next Version	CMS156v10	CMS156v11	No Version Available
Previous Version	No Version Available	CMS156v9	CMS156v10

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CMS156v10.html	142.55 KB
CMS156v10.zip	132.55 KB
CMS156v10-TRN.xlsx	23.25 KB

*Note: There is a known issue on CMS156v10. See issue EKI-17 on the ONC eCQM Known Issues Dashboard for details.

Data Element Repository

Data Elements contained within CMS156v10

Value Sets

Value Sets to be used with CMS156v10

Release Notes

CMS156v10-TRN.xlsx

Header

Updated the eCQM version number.

Measure Section: eCQM Version Number

Source of Change: Standards Update
Revised the description to add a new rate (rate 2).

Measure Section: Description

Source of Change: Measure Lead
Revised the measure description to align with the measure intent and guidance.

Measure Section: Description

Source of Change: Measure Lead
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: Standards Update
Revised the definition to clarify timing related to the Index Prescription Start Date.

Measure Section: Definition

Source of Change: Measure Lead
Updated the guidance to clarify the measure intent and support implementation.

Measure Section: Guidance

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
Updated the Denominator Exclusions to add an exclusion for palliative care.

Measure Section: Denominator Exclusions

Source of Change: Measure Lead
Revised the numerator to add a new rate (rate 2).

Measure Section: Numerator

Source of Change: Measure Lead
Revised the numerator to add a new rate (rate 2).

Measure Section: Numerator Exclusions

Source of Change: Measure Lead

Logic

Added online assessments and telephone visits as appropriate encounters based on the increased use of telehealth services.

Measure Section: Initial Population

Source of Change: Measure Lead
Updated Denominator Exclusions definition and added PalliativeCare.Palliative Care in the Measurement Period definition to add an exclusion for palliative care.

Measure Section: Denominator Exclusions

Source of Change: Measure Lead
Revised the numerator logic to add a new rate (rate 2).

Measure Section: Numerator

Source of Change: Measure Lead
Added exclusion criteria for numerator 2 to align with the American Geriatric Society Beers Criteria for Potentially Inappropriate Medication Use in Older Adults.

Measure Section: Numerator Exclusions

Source of Change: Measure Lead
Removed the days supply requirement for nonbenzodiazepine hypnotics by removing the Cumulative Medication Duration requirement for Hypnotics During Measurement Period in the Two High Risk Medications with Prolonged Duration definition and deleting the Hypnotics During Measurement Period definition to align with the American Geriatric Society Beers Criteria for Potentially Inappropriate Medication Use in Older Adults.

Measure Section: Definitions

Source of Change: Measure Lead
Updated Denominator Exclusions definition and added PalliativeCare.Palliative Care in the Measurement Period definition to add an exclusion for palliative care.

Measure Section: Definitions

Source of Change: Measure Lead
Updated the names of Clinical Quality Language (CQL) definitions, functions, and/or aliases for clarification and to align with the CQL Style Guide.

Measure Section: Multiple Sections

Source of Change: Standards Update
Removed and added medications to the Same High Risk Medications Ordered on Different Days definition to align with the American Geriatric Society Beers Criteria for Potentially Inappropriate Medication Use in Older Adults.

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
Updated Hospice CQL Library to version 3.0.000.

Measure Section: Multiple Sections

Source of Change: Measure Lead
Added PalliativeCareExclusion CQL library to version 1.0.000.

Measure Section: Multiple Sections

Source of Change: Measure Lead

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 Meprobamate (2.16.840.1.113883.3.464.1003.196.12.1284): Deleted 1 RxNorm code (197930) 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
Value set Trimipramine (2.16.840.1.113883.3.464.1003.196.12.1285): Deleted 6 RxNorm codes (199820, 313497, 245372, 245373, 245374, 250033) 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
Value set Diphenhydramine (2.16.840.1.113883.3.464.1003.196.12.1293): Deleted 37 RxNorm 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
Value set Dexchlorpheniramine (2.16.840.1.113883.3.464.1003.196.12.1300): Deleted 7 RxNorm codes (2184088, 1305775, 1357940, 1370680, 2168002, 2184127, 2184130) 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
Value set Orphenadrine (2.16.840.1.113883.3.464.1003.196.12.1302): Deleted 6 RxNorm codes (994824, 994810, 994811, 994837, 994841, 994847) 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
Value set Carbinoxamine (2.16.840.1.113883.3.464.1003.196.12.1306): Added 1 RxNorm code (359329) based on updated evidence in published guidelines, published literature, or from published specialty medical society or group recommendations. Deleted 6 RxNorm codes (1010946, 1010980, 1012681, 1012956, 1012984, 1424307) 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
Value set Clemastine (2.16.840.1.113883.3.464.1003.196.12.1308): Deleted 3 RxNorm codes (857452, 857454, 857457) 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
Value set Disopyramide (2.16.840.1.113883.3.464.1003.196.12.1311): Deleted 3 RxNorm codes (104285, 199730, 199824) 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
Value set Methyldopa (2.16.840.1.113883.3.464.1003.196.12.1331): Deleted 5 RxNorm codes (104357, 197955, 197959, 197961, 197962) 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
Value set Trihexyphenidyl (2.16.840.1.113883.3.464.1003.196.12.1334): Deleted 1 RxNorm code (905292) 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
Value set Clomipramine (2.16.840.1.113883.3.464.1003.196.12.1336): Deleted 5 RxNorm codes (857291, 857296, 857315, 857292, 857326) 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
Value set Megestrol (2.16.840.1.113883.3.464.1003.196.12.1342): Deleted 1 RxNorm code (860231) 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
Value set Phenobarbital (2.16.840.1.113883.3.464.1003.196.12.1348): Added 5 RxNorm codes (1046787, 1046815, 1046997, 1048147, 702519) based on updated evidence in published guidelines, published literature, or from published specialty medical society or group recommendations. Deleted 14 RxNorm 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
Value set Dipyridamole (2.16.840.1.113883.3.464.1003.196.12.1349): Deleted 2 RxNorm codes (199314, 392451) 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
Value set Nifedipine (2.16.840.1.113883.3.464.1003.196.12.1353): Deleted 5 RxNorm codes (199329, 314132, 199782, 391901, 391980) 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
Value set Desiccated Thyroid (2.16.840.1.113883.3.464.1003.196.12.1354): Deleted 1 RxNorm code (242927) 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
Value set Imipramine (2.16.840.1.113883.3.464.1003.196.12.1359): Deleted 1 RxNorm code (835586) 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
Value set Indomethacin (2.16.840.1.113883.3.464.1003.196.12.1366): Deleted 2 RxNorm codes (251255, 392073) 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
Value set Promethazine Hydrochloride (2.16.840.1.113883.3.464.1003.196.12.1367): Deleted 7 RxNorm codes (861578, 992900, 756160, 992471, 992898, 992904, 992908) 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
Value set Glyburide (2.16.840.1.113883.3.464.1003.196.12.1368): Deleted 1 RxNorm code (252960) 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
Value set Carisoprodol (2.16.840.1.113883.3.464.1003.196.12.1369): Deleted 1 RxNorm code (105974) based on terminology update.

Measure Section: Terminology

Source of Change: Annual Update
Value set Methocarbamol (2.16.840.1.113883.3.464.1003.196.12.1370): Deleted 1 RxNorm code (197945) 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
Removed value set Diphenhydramine Hydrochloride (2.16.840.1.113883.3.464.1003.196.12.1371) based on change in measure requirements/measure specification.

Measure Section: Terminology

Source of Change: Measure Lead
Value set Cyclobenzaprine Hydrochloride (2.16.840.1.113883.3.464.1003.196.12.1372): Deleted 1 RxNorm code (999731) 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
Value set Dexbrompheniramine (2.16.840.1.113883.3.464.1003.196.12.1375): Added 1 RxNorm code (2391334) based on updated evidence in published guidelines, published literature, or from published specialty medical society or group recommendations. Deleted 2 RxNorm codes (1251806, 1305588) 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
Value set Butabarbital (2.16.840.1.113883.3.464.1003.196.12.1402): Deleted 4 RxNorm codes (1047805, 1251600, 1251610, 1251625) 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
Value set Triprolidine (2.16.840.1.113883.3.464.1003.196.12.1408): Deleted 2 RxNorm codes (1099711, 996640) 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
Value set Esterified Estrogens (2.16.840.1.113883.3.464.1003.196.12.1419): Added 2 RxNorm codes (197670, 238006) based on updated evidence in published guidelines, published literature, or from published specialty medical society or group recommendations. Deleted 1 RxNorm code (1000353) 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
Value set Chlorpheniramine (2.16.840.1.113883.3.464.1003.196.12.1352): Added 1 RxNorm code (2383312) based on updated evidence in published guidelines, published literature, or from published specialty medical society or group recommendations. Deleted 100 RxNorm 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
Value set Conjugated Estrogens (2.16.840.1.113883.3.464.1003.196.12.1357): Added 4 RxNorm codes (1000351, 1000352, 1000355, 1000356) based on updated evidence in published guidelines, published literature, or from published specialty medical society or group recommendations. Deleted 4 RxNorm codes (1000353, 1000354, 197663, 432572) 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
Value set Ketorolac Tromethamine (2.16.840.1.113883.3.464.1003.196.12.1364): Added 8 RxNorm codes (1665459, 1665461, 1665675, 1665679,1665682, 860113, 860114, 860115) based on updated evidence in published guidelines, published literature, or from published specialty medical society or group recommendations. Deleted 1 RxNorm code (861846) 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
Value set Estradiol (2.16.840.1.113883.3.464.1003.196.12.1365): Added 2 RxNorm codes (2371764, 2371767) based on updated evidence in published guidelines, published literature, or from published specialty medical society or group recommendations. Deleted 5 RxNorm codes (249869, 1000161, 250213, 250838, 483169) 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
Value set Hydroxyzine (2.16.840.1.113883.3.464.1003.196.12.1374): Deleted 2 RxNorm codes (995428, 995274) 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
Value set Brompheniramine (2.16.840.1.113883.3.464.1003.196.12.1427): Added 11 RxNorm codes (1357013, 1014331, 1053258, 1090463, 1098497, 1098498, 1111065, 1148155, 1192477, 1244523, 1245722) based on review by technical experts, SMEs, and/or public feedback. Deleted 34 RxNorm codes based on review by technical experts, SMEs, and/or public feedback.

Measure Section: Terminology

Source of Change: Measure Lead
Value set Meperidine (2.16.840.1.113883.3.464.1003.196.12.1351): Added 15 RxNorm codes based on updated evidence in published guidelines, published literature, or from published specialty medical society or group recommendations. Deleted 1 RxNorm code (861578) 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
Value set Dicyclomine (2.16.840.1.113883.3.464.1003.196.12.1279): Deleted 4 RxNorm codes (991616, 199725, 755900, 991151) 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
Value set Dimenhydrinate (2.16.840.1.113883.3.464.1003.196.12.1500): Deleted 5 RxNorm codes (1294446, 245357, 245358, 429720, 755901) 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
Value set Hyoscyamine (2.16.840.1.113883.3.464.1003.196.12.1501): Deleted 5 RxNorm codes (1044608, 1046820, 1047805, 1048078, 1048411) 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
Value set Meclizine (2.16.840.1.113883.3.464.1003.196.12.1506): Deleted 1 RxNorm code (995682) 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
Value set Nortriptyline (2.16.840.1.113883.3.464.1003.196.12.1507): Deleted 4 RxNorm codes (199283, 199406, 865143, 865146) 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
Value set List of Single RxNorm Code Concepts for High Risk Drugs for the Elderly (2.16.840.1.113883.3.464.1003.196.12.1272): Added 2 RxNorm codes (308170, 318179) based on change in measure requirements/measure specification. Deleted 3 RxNorm codes (860771, 889614, 1363513) 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
Value set Nonbenzodiazepine hypnotics (2.16.840.1.113883.3.464.1003.196.12.1480): Deleted 2 RxNorm codes (854885, 854886) 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
Removed value set Amobarbital (2.16.840.1.113883.3.464.1003.196.12.1512) based on terminology update.

Measure Section: Terminology

Source of Change: Annual Update
Value set Butalbital (2.16.840.1.113883.3.464.1003.196.12.1514): Deleted 6 RxNorm codes (197425, 197427, 197428, 240093, 308322, 476152) 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
Value set Doxylamine (2.16.840.1.113883.3.464.1003.196.12.1515): Deleted 29 RxNorm codes based on validity of code during timing of look back period or 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
Removed value set Ergoloid Mesylates (2.16.840.1.113883.3.464.1003.196.12.1516) based on change in measure requirements/measure specification.

Measure Section: Terminology

Source of Change: Measure Lead
Value set Propantheline (2.16.840.1.113883.3.464.1003.196.12.1519): Deleted 1 RxNorm code (312673) 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
Value set Scopolamine (2.16.840.1.113883.3.464.1003.196.12.1520): Deleted 9 RxNorm codes (1048078, 106507, 199442, 200059, 245350, 250536, 250537, 412723, 429720) 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
Value set Secobarbital (2.16.840.1.113883.3.464.1003.196.12.1521): Deleted 3 RxNorm codes (308167, 308171, 315201) 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 Alcohol Withdrawal (2.16.840.1.113883.3.464.1003.105.12.1209) based on change in measure requirements/measure specification.

Measure Section: Terminology

Source of Change: Measure Lead
Added value set Benzodiazepine (2.16.840.1.113883.3.464.1003.196.12.1522) based on change in measure requirements/measure specification.

Measure Section: Terminology

Source of Change: Measure Lead
Added value set Benzodiazepine Withdrawal (2.16.840.1.113883.3.464.1003.105.12.1208) based on change in measure requirements/measure specification.

Measure Section: Terminology

Source of Change: Measure Lead
Added value set Bipolar Disorder (2.16.840.1.113883.3.464.1003.105.12.1157) based on change in measure requirements/measure specification.

Measure Section: Terminology

Source of Change: Measure Lead
Added value set General Anxiety Disorder (2.16.840.1.113883.3.464.1003.105.12.1210) based on change in measure requirements/measure specification.

Measure Section: Terminology

Source of Change: Measure Lead
Added value set Other Bipolar Disorder (2.16.840.1.113883.3.464.1003.105.12.1204) based on change in measure requirements/measure specification.

Measure Section: Terminology

Source of Change: Measure Lead
Added value set REM Sleep Behavior Disorder (2.16.840.1.113883.3.464.1003.105.12.1207) based on change in measure requirements/measure specification.

Measure Section: Terminology

Source of Change: Measure Lead
Added value set Schizophrenia (2.16.840.1.113883.3.464.1003.105.12.1205) based on change in measure requirements/measure specification.

Measure Section: Terminology

Source of Change: Measure Lead
Added value set Seizure Disorder (2.16.840.1.113883.3.464.1003.105.12.1206) based on change in measure requirements/measure specification.

Measure Section: Terminology

Source of Change: Measure Lead
Added value set Methscopolamine (2.16.840.1.113883.3.464.1003.196.12.1525) based on change in measure requirements/measure specification.

Measure Section: Terminology

Source of Change: Measure Lead
Added value set Telephone Visits (2.16.840.1.113883.3.464.1003.101.12.1080) based on review by technical experts, SMEs, and/or public feedback.

Measure Section: Terminology

Source of Change: Measure Lead
Added value set Online Assessment (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 value set Palliative Care Encounter (2.16.840.1.113883.3.464.1003.101.12.1090) based on change in measure requirements/measure specification.

Measure Section: Terminology

Source of Change: Measure Lead
Added value set Palliative Care Intervention (2.16.840.1.113883.3.464.1003.198.12.1135) based on change in measure requirements/measure specification.

Measure Section: Terminology

Source of Change: Measure Lead
Added direct reference code CPT code (99211) based on change in measure requirements/measure specification.

Measure Section: Terminology

Source of Change: Measure Lead
Added direct reference code LOINC code (71007-9) based on change in measure requirements/measure specification.

Measure Section: Terminology

Source of Change: Measure Lead