# Use of High-Risk Medications in Older Adults

### Compare Versions of: "Use of High-Risk Medications in Older Adults"

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Measure Information | 2022 Performance Period | 2023 Performance Period | 2024 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 | CMS156v10 | CMS156v11 | CMS156v12 |

NQF Number | Not Applicable | Not Applicable | 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). |
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 at the end of the measurement period 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 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. | 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 |
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). |
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 except for appropriate diagnoses. a. Patients with two or more antipsychotic prescriptions ordered on different days, and who did not 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. b. Patients with two or more benzodiazepine prescriptions ordered on different days, and who did not 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. 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. |
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. |
Not Applicable |

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 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. |
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 | No Version Available | ||

Previous Version | No Version Available | ||

Notes |
*There is a known issue on CMS156v10. See issue EKI-17 on the ONC eCQM Known Issues Dashboard for details. |
*There is a known issue on CMS156v11. See issue EKI-17 on the ONC eCQM Known Issues Dashboard for details. |

*There is a known issue on CMS156v11. See issue EKI-17 on the ONC eCQM Known Issues Dashboard for details.

### Data Element Repository

#### Header

Updated copyright.

**Measure Section:**Copyright**Source of Change:**Annual UpdateUpdated the rationale to provide more recent evidence to support the measure.

**Measure Section:**Rationale**Source of Change:**Measure LeadAdded language to the clinical recommendation statement to clarify measure intent.

**Measure Section:**Clinical Recommendation Statement**Source of Change:**Measure LeadUpdated references.

**Measure Section:**Reference**Source of Change:**Measure LeadAdded definition for 'order' to allow an order to be identified as a prescription order or a prescription refill to meet the measure requirement of two orders.

**Measure Section:**Definition**Source of Change:**Measure LeadUpdated version number of the Quality Data Model (QDM) used in the measure specification to v5.6.

**Measure Section:**Guidance**Source of Change:**Standards/Technical UpdateUpdated the guidance to clarify that at least two high-risk medications 'from the same drug class' are required, not 'two of the same high-risk medications'.

**Measure Section:**Guidance**Source of Change:**Measure LeadRevised the palliative care exclusion language to clarify the timing requirement.

**Measure Section:**Denominator Exclusions**Source of Change:**Measure LeadAdded detail within the definition, guidance, and numerator narrative to reflect the addition of high-risk average daily dose criteria to Numerator 1 based on clinical recommendations.

**Measure Section:**Multiple Sections**Source of Change:**Measure LeadUpdated grammar and punctuation to improve readability.

**Measure Section:**Multiple Sections**Source of Change:**Measure LeadUpdated the narrative to define acronyms at first use to improve readability.

**Measure Section:**Multiple Sections**Source of Change:**Measure Lead

#### Logic

Added QDM datatype Diagnosis to provide an alternate approach for identifying patients receiving palliative care.

**Measure Section:**Definitions**Source of Change:**Measure LeadUpdated the timing precision in the definitions from datetime to date by adding 'day of', 'date from', and/or function 'ToDateInterval' to align with the measure intent.

**Measure Section:**Definitions**Source of Change:**Measure LeadUpdated logic and terminology to align with the measure intent to require at least two high-risk medications 'from the same drug class' as opposed to 'two of the same high-risk medications'.

**Measure Section:**Definitions**Source of Change:**Measure LeadAdded QDM datatypes Encounter, Performed and Assessment, Performed and associated logic to the Hospice.'Has Hospice Services' definition to provide additional approaches for identifying patients receiving hospice services.

**Measure Section:**Definitions**Source of Change:**Measure LeadUpdated the measure to look for refills counting towards numerator compliance by updating the function More Than One Order, and to look for orders occurring on different dates rather than at least 24 hours apart.

**Measure Section:**Multiple Sections**Source of Change:**Measure LeadRevised the medication duration calculation method by replacing the approach of counting days during a Medication Order relevantPeriod to the approach of counting Medication Order days supply, which captures the medication duration more accurately.

**Measure Section:**Multiple Sections**Source of Change:**Measure LeadUpdated the version of the Quality Data Model (QDM) to 5.6 and Clinical Quality Language (CQL) to 1.5.

**Measure Section:**Multiple Sections**Source of Change:**Standards/Technical UpdateUpdated the version number of the Palliative Care Exclusion Library to v2.0.000.

**Measure Section:**Multiple Sections**Source of Change:**Measure LeadUpdated the version number of the Hospice Library to v4.0.000.

**Measure Section:**Multiple Sections**Source of Change:**Measure LeadAdded Cumulative Medication Duration Library v1.0.000.

**Measure Section:**Multiple Sections**Source of Change:**Measure LeadUpdated the version number of the Measure Authoring Tool (MAT) Global Common Functions Library to v7.0.000.

**Measure Section:**Multiple Sections**Source of Change:**Standards/Technical UpdateUpdated the names of CQL definitions, functions, and/or aliases for clarification and to align with the CQL Style Guide.

**Measure Section:**Multiple Sections**Source of Change:**Standards/Technical UpdateReplaced the Global.CalendarAgeInYearsAt function with the native CQL function AgeInYearsAt to take advantage of existing CQL features and increase human readability. As a result of this change, the LOINC code 21112-8 is no longer required and has been removed from the Terminology section of the human readable specification.

**Measure Section:**Multiple Sections**Source of Change:**Measure LeadAdded logic and terminology to reflect the addition of high-risk average daily dose criteria to Numerator 1 based on clinical recommendations.

**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 Palliative Care Intervention (2.16.840.1.113883.3.464.1003.198.12.1135): Added 3 SNOMED CT codes (305686008, 305824005, 441874000) based on review by technical experts, SMEs, and/or public feedback.

**Measure Section:**Terminology**Source of Change:**Measure LeadValue set Antipsychotic (2.16.840.1.113883.3.464.1003.196.12.1523): Added 8 RxNorm codes (2570392, 2570399, 2570402, 2570405, 2570418, 2570420, 991053, 991332) based on review by technical experts, SMEs, and/or public feedback.

**Measure Section:**Terminology**Source of Change:**Measure LeadValue set Benzodiazepine (2.16.840.1.113883.3.464.1003.196.12.1522): Added 10 RxNorm codes (197653, 197654, 198183, 198317, 198318, 2541170, 2541171, 2569564, 2569573, 2569577) based on review by technical experts, SMEs, and/or public feedback.

**Measure Section:**Terminology**Source of Change:**Measure LeadValue set Seizure Disorder (2.16.840.1.113883.3.464.1003.105.12.1206): Added 3 SNOMED CT codes (191714002, 230455006, 322112361000132104) based on review by technical experts, SMEs, and/or public feedback. Deleted 3 SNOMED CT codes (68448003, 192992007, 77450009) based on review by technical experts, SMEs, and/or public feedback.

**Measure Section:**Terminology**Source of Change:**Measure LeadRemoved direct reference code LOINC code (21112-8) based on review by technical experts, SMEs, and/or public feedback.

**Measure Section:**Terminology**Source of Change:**Measure LeadAdded direct reference code RxNorm code (1000048) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadAdded direct reference code RxNorm code (1000064) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadAdded direct reference code RxNorm code (1000058) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadRemoved value set Triprolidine (2.16.840.1.113883.3.464.1003.196.12.1408) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadAdded direct reference code RxNorm code (1000070) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadAdded direct reference code RxNorm code (1000076) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadAdded direct reference code RxNorm code (1000097) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadAdded direct reference code RxNorm code (1000054) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadRemoved value set Trimipramine (2.16.840.1.113883.3.464.1003.196.12.1285) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadRemoved value set Methyldopa (2.16.840.1.113883.3.464.1003.196.12.1331) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadRemoved value set Secobarbital (2.16.840.1.113883.3.464.1003.196.12.1521) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadRemoved value set Scopolamine (2.16.840.1.113883.3.464.1003.196.12.1520) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadRemoved value set Pyrilamine (2.16.840.1.113883.3.464.1003.196.12.1524) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadRemoved value set Protriptyline (2.16.840.1.113883.3.464.1003.196.12.1509) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadRemoved value set Propantheline (2.16.840.1.113883.3.464.1003.196.12.1519) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadRemoved value set Promethazine Hydrochloride (2.16.840.1.113883.3.464.1003.196.12.1367) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadRemoved value set Phenobarbital (2.16.840.1.113883.3.464.1003.196.12.1348) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadRemoved value set Pentobarbital (2.16.840.1.113883.3.464.1003.196.12.1518) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadRemoved value set Paroxetine (2.16.840.1.113883.3.464.1003.196.12.1508) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadRemoved value set Orphenadrine (2.16.840.1.113883.3.464.1003.196.12.1302) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadRemoved value set Nortriptyline (2.16.840.1.113883.3.464.1003.196.12.1507) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadRemoved value set Nifedipine (2.16.840.1.113883.3.464.1003.196.12.1353) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadAdded direct reference code RxNorm code (104208) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadRemoved value set Trihexyphenidyl (2.16.840.1.113883.3.464.1003.196.12.1334) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadAdded direct reference code RxNorm code (1441565) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadAdded direct reference code SNOMED CT code (307468000) based on review by technical experts, SMEs, and/or public feedback.

**Measure Section:**Terminology**Source of Change:**Measure LeadAdded direct reference code RxNorm code (197606) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadAdded direct reference code SNOMED CT code (396111001) based on review by technical experts, SMEs, and/or public feedback.

**Measure Section:**Terminology**Source of Change:**Measure LeadAdded direct reference code SNOMED CT code (229799001) based on review by technical experts, SMEs, and/or public feedback.

**Measure Section:**Terminology**Source of Change:**Measure LeadAdded direct reference code SNOMED CT code (229798009) based on review by technical experts, SMEs, and/or public feedback.

**Measure Section:**Terminology**Source of Change:**Measure LeadAdded direct reference code SNOMED CT code (396107007) based on review by technical experts, SMEs, and/or public feedback.

**Measure Section:**Terminology**Source of Change:**Measure LeadAdded direct reference code SNOMED CT code (396108002) based on review by technical experts, SMEs, and/or public feedback.

**Measure Section:**Terminology**Source of Change:**Measure LeadAdded direct reference code SNOMED CT code (396109005) based on review by technical experts, SMEs, and/or public feedback.

**Measure Section:**Terminology**Source of Change:**Measure LeadAdded direct reference code SNOMED CT code (229797004) based on review by technical experts, SMEs, and/or public feedback.

**Measure Section:**Terminology**Source of Change:**Measure LeadAdded direct reference code LOINC code (45755-6) based on review by technical experts, SMEs, and/or public feedback.

**Measure Section:**Terminology**Source of Change:**Measure LeadAdded direct reference code SNOMED CT code (307439001) based on review by technical experts, SMEs, and/or public feedback.

**Measure Section:**Terminology**Source of Change:**Measure LeadAdded direct reference code SNOMED CT code (225752000) based on review by technical experts, SMEs, and/or public feedback.

**Measure Section:**Terminology**Source of Change:**Measure LeadAdded direct reference code SNOMED CT code (396125000) based on review by technical experts, SMEs, and/or public feedback.

**Measure Section:**Terminology**Source of Change:**Measure LeadAdded direct reference code SNOMED CT code (307470009) based on review by technical experts, SMEs, and/or public feedback.

**Measure Section:**Terminology**Source of Change:**Measure LeadAdded direct reference code SNOMED CT code (396127008) based on review by technical experts, SMEs, and/or public feedback.

**Measure Section:**Terminology**Source of Change:**Measure LeadAdded direct reference code SNOMED CT code (225754004) based on review by technical experts, SMEs, and/or public feedback.

**Measure Section:**Terminology**Source of Change:**Measure LeadAdded direct reference code SNOMED CT code (396126004) based on review by technical experts, SMEs, and/or public feedback.

**Measure Section:**Terminology**Source of Change:**Measure LeadAdded direct reference code SNOMED CT code (396139000) based on review by technical experts, SMEs, and/or public feedback.

**Measure Section:**Terminology**Source of Change:**Measure LeadRemoved 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 LeadAdded direct reference code SNOMED CT code (396143001) based on review by technical experts, SMEs, and/or public feedback.

**Measure Section:**Terminology**Source of Change:**Measure LeadAdded direct reference code SNOMED CT code (225756002) based on review by technical experts, SMEs, and/or public feedback.

**Measure Section:**Terminology**Source of Change:**Measure LeadAdded direct reference code SNOMED CT code (396131002) based on review by technical experts, SMEs, and/or public feedback.

**Measure Section:**Terminology**Source of Change:**Measure LeadAdded direct reference code SNOMED CT code (396140003) based on review by technical experts, SMEs, and/or public feedback.

**Measure Section:**Terminology**Source of Change:**Measure LeadAdded direct reference code SNOMED CT code (307469008) based on review by technical experts, SMEs, and/or public feedback.

**Measure Section:**Terminology**Source of Change:**Measure LeadAdded direct reference code RxNorm code (966793) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadAdded direct reference code RxNorm code (966787) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadAdded direct reference code RxNorm code (393245) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadAdded direct reference code RxNorm code (245273) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadAdded direct reference code RxNorm code (204504) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadAdded direct reference code RxNorm code (198197) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadAdded direct reference code RxNorm code (198196) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadAdded direct reference code RxNorm code (197604) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadRemoved value set Methocarbamol (2.16.840.1.113883.3.464.1003.196.12.1370) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadRemoved value set Estropipate (2.16.840.1.113883.3.464.1003.196.12.1319) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadRemoved value set Meprobamate (2.16.840.1.113883.3.464.1003.196.12.1284) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadRemoved value set Carisoprodol (2.16.840.1.113883.3.464.1003.196.12.1369) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadRemoved value set Carbinoxamine (2.16.840.1.113883.3.464.1003.196.12.1306) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadRemoved value set Butalbital (2.16.840.1.113883.3.464.1003.196.12.1514) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadRemoved value set Butabarbital (2.16.840.1.113883.3.464.1003.196.12.1402) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadRemoved value set Brompheniramine (2.16.840.1.113883.3.464.1003.196.12.1427) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadRemoved value set Benztropine (2.16.840.1.113883.3.464.1003.196.12.1361) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadRemoved value set Atropine (2.16.840.1.113883.3.464.1003.196.12.1274) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadRemoved value set Amoxapine (2.16.840.1.113883.3.464.1003.196.12.1273) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadRemoved value set Amitriptyline Hydrochloride (2.16.840.1.113883.3.464.1003.196.12.1373) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadAdded value set Endocrine system, sulfonylureas, long duration (2.16.840.1.113883.3.464.1003.1059) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadAdded value set Central nervous system, other (2.16.840.1.113883.3.464.1003.1057) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadAdded value set Endocrine system, estrogens with or without progestins (2.16.840.1.113883.3.464.1003.1058) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadAdded value set Central nervous system, barbiturates (2.16.840.1.113883.3.464.1003.1055) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadAdded value set Central nervous system, vasodilators (2.16.840.1.113883.3.464.1003.1056) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadAdded value set Cardiovascular, other (2.16.840.1.113883.3.464.1003.1053) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadAdded value set Central nervous system, antidepressants (2.16.840.1.113883.3.464.1003.1054) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadAdded value set Antithrombotic (2.16.840.1.113883.3.464.1003.1051) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadAdded value set Cardiovascular, alpha agonists, central (2.16.840.1.113883.3.464.1003.1052) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadAdded value set Antispasmodics (2.16.840.1.113883.3.464.1003.1050) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadAdded value set Anticholinergics, anti Parkinson agents (2.16.840.1.113883.3.464.1003.1049) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadAdded value set Hospice Encounter (2.16.840.1.113883.3.464.1003.1003) based on review by technical experts, SMEs, and/or public feedback.

**Measure Section:**Terminology**Source of Change:**Measure LeadAdded value set Reserpine (2.16.840.1.113883.3.464.1003.1044) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadAdded value set Anticholinergics, first generation antihistamines (2.16.840.1.113883.3.464.1003.1043) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadAdded value set Doxepin (2.16.840.1.113883.3.464.1003.1067) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadAdded value set Digoxin (2.16.840.1.113883.3.464.1003.1065) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadAdded value set Pain medications, skeletal muscle relaxants (2.16.840.1.113883.3.464.1003.1062) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadAdded value set Pain medications, other (2.16.840.1.113883.3.464.1003.1063) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadAdded value set Endocrine system, other (2.16.840.1.113883.3.464.1003.1060) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadReplaced value set Hospice Care Ambulatory (2.16.840.1.113762.1.4.1108.15) with value set Hospice Care Ambulatory (2.16.840.1.113883.3.526.3.1584) based on review by technical experts, SMEs, and/or public feedback.

**Measure Section:**Terminology**Source of Change:**Measure LeadRemoved value set Chlorpheniramine (2.16.840.1.113883.3.464.1003.196.12.1352) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadRemoved value set Metaxalone (2.16.840.1.113883.3.464.1003.196.12.1358) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadRemoved value set Chlorpropamide (2.16.840.1.113883.3.464.1003.196.12.1303) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadRemoved value set Clemastine (2.16.840.1.113883.3.464.1003.196.12.1308) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadRemoved value set Meperidine (2.16.840.1.113883.3.464.1003.196.12.1351) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadRemoved value set Megestrol (2.16.840.1.113883.3.464.1003.196.12.1342) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadRemoved value set Meclizine (2.16.840.1.113883.3.464.1003.196.12.1506) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadRemoved 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) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadRemoved value set Ketorolac Tromethamine (2.16.840.1.113883.3.464.1003.196.12.1364) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadRemoved value set Isoxsuprine (2.16.840.1.113883.3.464.1003.196.12.1422) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadRemoved value set Indomethacin (2.16.840.1.113883.3.464.1003.196.12.1366) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadRemoved value set Imipramine (2.16.840.1.113883.3.464.1003.196.12.1359) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadRemoved value set Hyoscyamine (2.16.840.1.113883.3.464.1003.196.12.1501) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadRemoved value set Hydroxyzine (2.16.840.1.113883.3.464.1003.196.12.1374) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadRemoved value set Guanfacine (2.16.840.1.113883.3.464.1003.196.12.1341) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadRemoved value set Glyburide (2.16.840.1.113883.3.464.1003.196.12.1368) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadAdded direct reference code SNOMED CT code (373066001) based on review by technical experts, SMEs, and/or public feedback.

**Measure Section:**Terminology**Source of Change:**Measure LeadRemoved value set Estradiol (2.16.840.1.113883.3.464.1003.196.12.1365) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadRemoved value set Esterified Estrogens (2.16.840.1.113883.3.464.1003.196.12.1419) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadRemoved value set Doxylamine (2.16.840.1.113883.3.464.1003.196.12.1515) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadRemoved value set Disopyramide (2.16.840.1.113883.3.464.1003.196.12.1311) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadRemoved value set Dipyridamole (2.16.840.1.113883.3.464.1003.196.12.1349) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadRemoved value set Diphenhydramine (2.16.840.1.113883.3.464.1003.196.12.1293) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadRemoved value set Dimenhydrinate (2.16.840.1.113883.3.464.1003.196.12.1500) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadRemoved value set Dicyclomine (2.16.840.1.113883.3.464.1003.196.12.1279) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadRemoved value set Dexchlorpheniramine (2.16.840.1.113883.3.464.1003.196.12.1300) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadRemoved value set Dexbrompheniramine (2.16.840.1.113883.3.464.1003.196.12.1375) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadRemoved value set Desipramine (2.16.840.1.113883.3.464.1003.196.12.1278) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadRemoved value set Desiccated Thyroid (2.16.840.1.113883.3.464.1003.196.12.1354) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadRemoved value set Cyproheptadine (2.16.840.1.113883.3.464.1003.196.12.1277) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadRemoved value set Cyclobenzaprine Hydrochloride (2.16.840.1.113883.3.464.1003.196.12.1372) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadRemoved value set Conjugated Estrogens (2.16.840.1.113883.3.464.1003.196.12.1357) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadRemoved value set Clomipramine (2.16.840.1.113883.3.464.1003.196.12.1336) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadRemoved value set Chlorzoxazone (2.16.840.1.113883.3.464.1003.196.12.1362) based on change in measure requirements/measure specification.

**Measure Section:**Terminology**Source of Change:**Measure LeadAdded direct reference code ICD-10-CM code (Z51.5) based on review by technical experts, SMEs, and/or public feedback.

**Measure Section:**Terminology**Source of Change:**Measure Lead