Measure Information  2023 Performance Period 

CMS eCQM ID  CMS156v11 
NQF Number  Not Applicable 
MIPS Quality ID  238 
Description 
Percentage of patients 65 years of age and older who were ordered at least two highrisk 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 highrisk medications from the same drug class. 2. Percentage of patients 65 years of age and older who were ordered at least two highrisk 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 at the end of the measurement period who had a visit during the measurement period 
Numerator 
Rate 1: Patients with at least two orders of highrisk medications from the same drug class on different days. a. At least two orders of highrisk medications from the same drug class. b. At least two orders of highrisk medications from the same drug class with summed days supply greater than 90 days. c. At least two orders of highrisk medications from the same drug class each exceeding average daily dose criteria. Rate 2: Patients with at least two orders of highrisk 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 
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 
Equals Initial Population 
Denominator Exclusions 
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. 
Denominator Exceptions 
None 
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 highrisk medication prescriptions from the same drug class on different days. The intent of the measure is to assess if the reporting provider ordered the highrisk medication(s). If the patient had a highrisk medication previously prescribed by another provider, they would not be counted towards the numerator unless the reporting provider also ordered a highrisk 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 30days 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 patientbased measure.
This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM. 
Telehealth Eligible  Yes 
Next Version  
Previous Version 
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.
Measure Information  2021 Performance Period  2022 Performance Period  2023 Performance Period  2024 Performance Period 

Title  Use of HighRisk Medications in Older Adults  Use of HighRisk Medications in Older Adults  Use of HighRisk Medications in Older Adults  Use of HighRisk Medications in Older Adults 
CMS eCQM ID  CMS156v9  CMS156v10  CMS156v11  CMS156v12 
NQF Number  Not Applicable  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 highrisk medications. 
Percentage of patients 65 years of age and older who were ordered at least two highrisk 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 highrisk medications from the same drug class. 2. Percentage of patients 65 years of age and older who were ordered at least two highrisk 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 highrisk 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 highrisk medications from the same drug class. 2. Percentage of patients 65 years of age and older who were ordered at least two highrisk 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 highrisk 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 highrisk medications from the same drug class. 2. Percentage of patients 65 years of age and older who were ordered at least two highrisk 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 
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 
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.  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 highrisk medication on different days during the measurement period 
Rate 1 : Patients with at least two orders of highrisk medications from the same drug class. Rate 2: Patients with at least two orders of highrisk 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 highrisk medications from the same drug class on different days. a. At least two orders of highrisk medications from the same drug class. b. At least two orders of highrisk medications from the same drug class with summed days supply greater than 90 days. c. At least two orders of highrisk medications from the same drug class each exceeding average daily dose criteria. Rate 2: Patients with at least two orders of highrisk 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 highrisk medications from the same drug class on different days. a. At least two orders of highrisk medications from the same drug class. b. At least two orders of highrisk medications from the same drug class with summed days supply greater than 90 days. c. At least two orders of highrisk medications from the same drug class each exceeding average daily dose criteria. Rate 2: Patients with at least two orders of highrisk 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 
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. 
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 
Lower score indicates better quality 
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 highrisk medications on different days. The intent of the measure is to assess if the reporting provider ordered the highrisk medication(s). If the patient had a highrisk medication previously prescribed by another provider, they would not be counted towards the numerator unless the reporting provider also ordered a highrisk medication for them. This eCQM is a patientbased 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 highrisk medication prescriptions from the same medication class on different days. The intent of the measure is to assess if the reporting provider ordered the highrisk medication(s). If the patient had a highrisk medication previously prescribed by another provider, they would not be counted towards the numerator unless the reporting provider also ordered a highrisk medication for them. This eCQM is a patientbased 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 highrisk medication prescriptions from the same drug class on different days. The intent of the measure is to assess if the reporting provider ordered the highrisk medication(s). If the patient had a highrisk medication previously prescribed by another provider, they would not be counted towards the numerator unless the reporting provider also ordered a highrisk 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 30days 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 patientbased 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 highrisk medication prescriptions from the same drug class on different days. The intent of the measure is to assess if the reporting provider ordered the highrisk medication(s). If the patient had a highrisk medication previously prescribed by another provider, they would not be counted towards the numerator unless the reporting provider also ordered a highrisk 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 30days 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 patientbased 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  238 
Telehealth Eligible  Yes  Yes  Yes  Yes 
Next Version  CMS156v10  CMS156v11  CMS156v12  No Version Available 
Previous Version  No Version Available 
*Note: There is a known issue on CMS156v11. See issue EKI17 on the ONC eCQM Known Issues Dashboard for details.
Data Element Repository
Header

Updated copyright.
Measure Section: Copyright
Source of Change: Annual Update

Updated the rationale to provide more recent evidence to support the measure.
Measure Section: Rationale
Source of Change: Measure Lead

Added language to the clinical recommendation statement to clarify measure intent.
Measure Section: Clinical Recommendation Statement
Source of Change: Measure Lead

Updated references.
Measure Section: Reference
Source of Change: Measure Lead

Added 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 Lead

Updated version number of the Quality Data Model (QDM) used in the measure specification to v5.6.
Measure Section: Guidance
Source of Change: Standards/Technical Update

Updated the guidance to clarify that at least two highrisk medications 'from the same drug class' are required, not 'two of the same highrisk medications'.
Measure Section: Guidance
Source of Change: Measure Lead

Revised the palliative care exclusion language to clarify the timing requirement.
Measure Section: Denominator Exclusions
Source of Change: Measure Lead

Added detail within the definition, guidance, and numerator narrative to reflect the addition of highrisk average daily dose criteria to Numerator 1 based on clinical recommendations.
Measure Section: Multiple Sections
Source of Change: Measure Lead

Updated grammar and punctuation to improve readability.
Measure Section: Multiple Sections
Source of Change: Measure Lead

Updated 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 Lead

Updated 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 Lead

Updated logic and terminology to align with the measure intent to require at least two highrisk medications 'from the same drug class' as opposed to 'two of the same highrisk medications'.
Measure Section: Definitions
Source of Change: Measure Lead

Added 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 Lead

Updated 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 Lead

Revised 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 Lead

Updated 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 Update

Updated the version number of the Palliative Care Exclusion Library to v2.0.000.
Measure Section: Multiple Sections
Source of Change: Measure Lead

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

Added Cumulative Medication Duration Library v1.0.000.
Measure Section: Multiple Sections
Source of Change: Measure Lead

Updated the version number of the Measure Authoring Tool (MAT) Global Common Functions Library to v7.0.000.
Measure Section: Multiple Sections
Source of Change: Standards/Technical Update

Updated 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 Update

Replaced 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 211128 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 Lead

Added logic and terminology to reflect the addition of highrisk 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 Lead

Value 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 Lead

Value 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 Lead

Value 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 Lead

Removed direct reference code LOINC code (211128) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead

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

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

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

Removed 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 Lead

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

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

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

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

Removed 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 Lead

Removed 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 Lead

Removed 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 Lead

Removed 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 Lead

Removed 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 Lead

Removed 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 Lead

Removed 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 Lead

Removed 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 Lead

Removed 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 Lead

Removed 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 Lead

Removed 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 Lead

Removed 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 Lead

Removed 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 Lead

Removed 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 Lead

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

Removed 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 Lead

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

Added 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 Lead

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

Added 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 Lead

Added 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 Lead

Added 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 Lead

Added 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 Lead

Added 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 Lead

Added 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 Lead

Added 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 Lead

Added direct reference code LOINC code (457556) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead

Added 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 Lead

Added 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 Lead

Added 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 Lead

Added 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 Lead

Added 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 Lead

Added 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 Lead

Added 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 Lead

Added 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 Lead

Removed 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 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 Lead

Added 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 Lead

Added 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 Lead

Added 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 Lead

Added 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 Lead

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

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

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

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

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

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

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

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

Removed 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 Lead

Removed 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 Lead

Removed 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 Lead

Removed 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 Lead

Removed 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 Lead

Removed 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 Lead

Removed 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 Lead

Removed 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 Lead

Removed 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 Lead

Removed 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 Lead

Removed 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 Lead

Removed 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 Lead

Added 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 Lead

Added 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 Lead

Added 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 Lead

Added 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 Lead

Added 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 Lead

Added 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 Lead

Added 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 Lead

Added 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 Lead

Added 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 Lead

Added 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 Lead

Added 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 Lead

Added 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 Lead

Added 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 Lead

Added 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 Lead

Added 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 Lead

Added 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 Lead

Added 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 Lead

Added 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 Lead

Added 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 Lead

Replaced 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 Lead

Removed 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 Lead

Removed 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 Lead

Removed 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 Lead

Removed 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 Lead

Removed 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 Lead

Removed 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 Lead

Removed 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 Lead

Removed 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 Lead

Removed 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 Lead

Removed 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 Lead

Removed 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 Lead

Removed 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 Lead

Removed 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 Lead

Removed 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 Lead

Removed 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 Lead

Removed 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 Lead

Added 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 Lead

Removed 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 Lead

Removed 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 Lead

Removed 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 Lead

Removed 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 Lead

Removed 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 Lead

Removed 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 Lead

Removed 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 Lead

Removed 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 Lead

Removed 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 Lead

Removed 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 Lead

Removed 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 Lead

Removed 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 Lead

Removed 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 Lead

Removed 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 Lead

Removed 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 Lead

Removed 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 Lead

Removed 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 Lead

Added direct reference code ICD10CM code (Z51.5) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead