Use of High-Risk Medications in Older Adults
Compare Versions of: "Use of High-Risk Medications in Older Adults"
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.
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Compare 2025 version to
Measure Information | 2025 Performance Period |
---|---|
Title | Use of High-Risk Medications in Older Adults |
CMS eCQM ID | CMS156v13 |
CBE ID* | Not Applicable |
MIPS Quality ID | 238 |
Measure Steward | National Committee for Quality Assurance |
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....Show more > |
Measure Scoring | Proportion measure |
Measure Type | Process |
Stratification |
None |
Risk Adjustment |
None |
Rationale | Certain medications (MacKinnon & Hepler, 2003) are associated with increased risk of harm from drug side-effects and drug toxicity and pose a concern for patient safety. There is clinical consensus that these drugs pose increased risks in older adults (Kaufman, Brodin, & Sarafian, 2005).... Show more > |
Clinical Recommendation Statement | The measure is based on recommendations from the American Geriatrics Society Beers Criteria[R] for Potentially Inappropriate Medication Use in Older Adults (2023). The criteria were developed through key clinical expert consensus processes by Beers in 1997, Zhan in 2001, Fick et al. in... Show more > |
Improvement Notation |
Lower score indicates better quality |
Definition | Index Prescription Start Date (IPSD). The start date of the earliest prescription ordered for a high-risk medication during the measurement period. A high-risk medication is identified by any one of the following:a. A prescription for medications classified as high risk at any dose and...Show more > |
Guidance | 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...Show more > |
Initial Population |
Patients 65 years and older at the end of the measurement period 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 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 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...Show more > |
Numerator Exclusions |
Not Applicable |
Denominator Exceptions |
None |
Telehealth Eligible | Yes |
Next Version | No Version Available |
Previous Version |
Additional Resources for CMS156v13
Header
Updated the eCQM version number.
Measure Section:
eCQM Version Number
Source of Change:
Annual Update
Changed all references from NQF to CBE to identify the consensus-based entity role.
Measure Section:
CBE Number
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Annual Update
Updated copyright.
Measure Section:
Copyright
Source of Change:
Annual Update
Updated language to account for updated drug lists based upon recommendations in the 2023 American Geriatrics Society Beers Criteria.
Measure Section:
Clinical Recommendation Statement
Source of Change:
Measure Lead
Updated language to account for updated drug lists based upon recommendations in the 2023 American Geriatrics Society Beers Criteria.
Measure Section:
Reference
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Measure Lead
Updated grammar, wording, and/or formatting to improve readability and consistency.
Measure Section:
Multiple Sections
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Annual Update
Updated references and measure header to reflect current evidence and new or updated literature.
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Multiple Sections
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Measure Lead
Logic
Updated the version number of the Palliative Care Exclusion Library to v4.0.000 and the library name from 'PalliativeCareExclusionECQM' to 'PalliativeCareQDM.'
Measure Section:
Definitions
Source of Change:
Annual Update
Updated the version number of the Measure Authoring Tool (MAT) Global Common Functions Library to v8.0.000 and the library name from 'MATGlobalCommonFunctions' to 'MATGlobalCommonFunctionsQDM.'
Measure Section:
Definitions
Source of Change:
Annual Update
Updated the version number of the Hospice Library to v6.0.000 and the library name from 'Hospice' to 'HospiceQDM.'
Measure Section:
Definitions
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Annual Update
Renamed value set to 'Payer Type' to more accurately reflect the contents and intent of the value set.
Measure Section:
Definitions
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Standards/Technical Update
Updated the following definitions to account for updated drug lists based upon recommendations in the 2023 American Geriatrics Society Beers Criteria: 'Antipsychotic Index Prescription Start Date', 'Benzodiazepine Index Prescription Start Date', 'High Risk Medications with Average Daily Dose Criteria', 'More than One Antipsychotic Order', 'More than One Benzodiazepine Order', 'Same High Risk Medications Ordered on Different Days', and 'Two High Risk Medications with Prolonged Duration.'
Measure Section:
Definitions
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Measure Lead
Updated the value set name for 'Online Assessments' to 'Virtual Encounter' for a more accurate description.
Measure Section:
Definitions
Source of Change:
Measure Lead
Updated the version number of the Measure Authoring Tool (MAT) Global Common Functions Library to v8.0.000 and the library name from 'MATGlobalCommonFunctions' to 'MATGlobalCommonFunctionsQDM.'
Measure Section:
Functions
Source of Change:
Annual Update
Updated the following functions to account for updated drug lists based upon recommendations in the 2023 American Geriatrics Society Beers Criteria: 'MedicationStrengthPerUnit.'
Measure Section:
Functions
Source of Change:
Measure Lead
Updated the version number of the Cumulative Medication Duration Library to v3.0.000 and the library name from 'CumulativeMedicationDuration' to 'CumulativeMedicationDurationQDM.'
Measure Section:
Functions
Source of Change:
Annual Update
Value Set
The VSAC is the source of truth for the value set content, please visit the VSAC for downloads of current value sets.
Removed ICD-9 extensional value sets from select grouping value sets, leaving codes from active terminologies (ICD-10 and SNOMED), to reduce implementer burden.
Measure Section:
Terminology
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Standards/Technical Update
Value set Annual Wellness Visit (2.16.840.1.113883.3.526.3.1240): Added 3 SNOMED CT codes (86013001, 90526000, 866149003) based on review by technical experts, SMEs, and/or public feedback. Added 1 HCPCS code (G0402) based on review by technical experts, SMEs, and/or public feedback.
Measure Section:
Terminology
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Measure Lead
Value set Potentially Harmful Antihistamines for Older Adults (2.16.840.1.113883.3.464.1003.1043): Added 45 RxNorm codes based on review by technical experts, SMEs, and/or public feedback. Deleted 103 RxNorm codes based on review by technical experts, SMEs, and/or public feedback.
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Terminology
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Measure Lead
Value set Potentially Harmful Gastrointestinal Antispasmodics for Older Adults (2.16.840.1.113883.3.464.1003.1050): Added 1 RxNorm code (2637557) based on review by technical experts, SMEs, and/or public feedback. Deleted 8 RxNorm codes (1111171, 1190793, 198165, 198207, 312104, 312107, 314088, 403914) based on review by technical experts, SMEs, and/or public feedback.
Measure Section:
Terminology
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Measure Lead
Value set Potentially Harmful Benzodiazepines for Older Adults (2.16.840.1.113883.3.464.1003.196.12.1522): Added 4 RxNorm codes (1366192, 199450, 246172, 427538) based on review by technical experts, SMEs, and/or public feedback. Deleted 3 RxNorm codes (1298088, 1298091, 198183) based on review by technical experts, SMEs, and/or public feedback.
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Terminology
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Measure Lead
Value set Benzodiazepine Withdrawal (2.16.840.1.113883.3.464.1003.105.12.1208): Deleted 1 SNOMED CT code (10028000) based on review by technical experts, SMEs, and/or public feedback.
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Terminology
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Measure Lead
Value set Bipolar Disorder (2.16.840.1.113883.3.67.1.101.1.128): Deleted 40 ICD-9-CM codes based on applicability of value set and/or OID.
Measure Section:
Terminology
Source of Change:
Annual Update
Removed value set Cardiovascular, alpha agonists, central (2.16.840.1.113883.3.464.1003.1052) based on review by technical experts, SMEs, and/or public feedback.
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Terminology
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Measure Lead
Value set Nifedipine Medications (2.16.840.1.113883.3.464.1003.1053): Deleted 4 RxNorm codes (309958, 309960, 636793, 636794) based on review by technical experts, SMEs, and/or public feedback.
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Terminology
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Measure Lead
Value set Care Services in Long Term Residential Facility (2.16.840.1.113883.3.464.1003.101.12.1014): Deleted 9 CPT codes (99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337) based on review by technical experts, SMEs, and/or public feedback.
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Terminology
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Measure Lead
Value set Potentially Harmful Antidepressants for Older Adults (2.16.840.1.113883.3.464.1003.1054): Deleted 5 RxNorm codes (313496, 313498, 313499, 905168, 905172) based on review by technical experts, SMEs, and/or public feedback.
Measure Section:
Terminology
Source of Change:
Measure Lead
Value set Potentially Harmful Barbiturates for Older Adults (2.16.840.1.113883.3.464.1003.1055): Added 6 RxNorm codes (198150, 2624719, 2671204, 2671207, 328176, 96304) based on review by technical experts, SMEs, and/or public feedback. Deleted 4 RxNorm codes (1251614, 238090, 308170, 312914) based on review by technical experts, SMEs, and/or public feedback.
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Terminology
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Measure Lead
Replaced value set Central nervous system, vasodilators (2.16.840.1.113883.3.464.1003.1056) with direct reference code RxNorm code (318179) based on applicability of a single code to represent clinical data.
Measure Section:
Terminology
Source of Change:
Annual Update
Value set (2.16.840.1.113883.3.464.1003.1060): Renamed to Desiccated Thyroid Medications based on recommended value set naming conventions.
Measure Section:
Terminology
Source of Change:
Annual Update
Value set Digoxin Medications (2.16.840.1.113883.3.464.1003.1065): Deleted 1 RxNorm code (1441565) based on review by technical experts, SMEs, and/or public feedback.
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Terminology
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Measure Lead
Value set (2.16.840.1.113883.3.464.1003.1065): Renamed to Digoxin Medications based on recommended value set naming conventions.
Measure Section:
Terminology
Source of Change:
Annual Update
Value set (2.16.840.1.113883.3.464.1003.1051): Renamed to Dipyridamole Medications based on recommended value set naming conventions.
Measure Section:
Terminology
Source of Change:
Annual Update
Value set (2.16.840.1.113883.3.464.1003.1067): Renamed to Doxepin Medications based on recommended value set naming conventions.
Measure Section:
Terminology
Source of Change:
Annual Update
Value set Desiccated Thyroid Medications (2.16.840.1.113883.3.464.1003.1060): Deleted 4 RxNorm codes (577154, 860215, 860221, 860225) based on review by technical experts, SMEs, and/or public feedback.
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Terminology
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Measure Lead
Value set Potentially Harmful Sulfonylureas for Older Adults (2.16.840.1.113883.3.464.1003.1059): Deleted 2 RxNorm codes (197495, 197496) based on review by technical experts, SMEs, and/or public feedback.
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Terminology
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Value set Generalized Anxiety Disorder (2.16.840.1.113883.3.464.1003.105.12.1210): Added 2 SNOMED CT codes (268669006, 71959007) based on review by technical experts, SMEs, and/or public feedback. Deleted 1 SNOMED CT code (238976006) based on review by technical experts, SMEs, and/or public feedback.
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Terminology
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Measure Lead
Added value set Guanfacine Medications (2.16.840.1.113883.3.464.1003.196.11.1252) based on review by technical experts, SMEs, and/or public feedback.
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Terminology
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Measure Lead
Value set Home Healthcare Services (2.16.840.1.113883.3.464.1003.101.12.1016): Deleted 1 CPT code (99343) based on review by technical experts, SMEs, and/or public feedback.
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Terminology
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Measure Lead
Value set Hospice Care Ambulatory (2.16.840.1.113883.3.526.3.1584): Added 2 SNOMED CT codes (170935008, 170936009) based on review by technical experts, SMEs, and/or public feedback. Deleted 1 SNOMED CT code (385765002) based on review by technical experts, SMEs, and/or public feedback.
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Terminology
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Measure Lead
Added value set Megestrol Medications (2.16.840.1.113883.3.464.1003.1247) based on review by technical experts, SMEs, and/or public feedback.
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Terminology
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Measure Lead
Added value set Meperidine Medications (2.16.840.1.113883.3.464.1003.1248) based on review by technical experts, SMEs, and/or public feedback.
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Terminology
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Measure Lead
Value set (2.16.840.1.113883.3.464.1003.1057): Renamed to Meprobamate Medications based on recommended value set naming conventions.
Measure Section:
Terminology
Source of Change:
Annual Update
Value set (2.16.840.1.113883.3.464.1003.1053): Renamed to Nifedipine Medications based on recommended value set naming conventions.
Measure Section:
Terminology
Source of Change:
Annual Update
Value set Nursing Facility Visit (2.16.840.1.113883.3.464.1003.101.12.1012): Deleted 1 CPT code (99318) based on review by technical experts, SMEs, and/or public feedback.
Measure Section:
Terminology
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Measure Lead
Value set Office Visit (2.16.840.1.113883.3.464.1003.101.12.1001): Deleted 2 SNOMED CT codes (30346009, 37894004) based on review by technical experts, SMEs, and/or public feedback. Deleted 1 CPT code (99201) based on review by technical experts, SMEs, and/or public feedback.
Measure Section:
Terminology
Source of Change:
Measure Lead
Value set Virtual Encounter (2.16.840.1.113883.3.464.1003.101.12.1089): Deleted 2 CPT codes (98969, 99444) based on review by technical experts, SMEs, and/or public feedback. Deleted 3 HCPCS codes (G2061, G2062, G2063) based on review by technical experts, SMEs, and/or public feedback.
Measure Section:
Terminology
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Measure Lead
Value set Potentially Harmful Pain Medications for Older Adults (2.16.840.1.113883.3.464.1003.1063): Deleted 18 RxNorm codes based on review by technical experts, SMEs, and/or public feedback.
Measure Section:
Terminology
Source of Change:
Measure Lead
Value set Potentially Harmful Skeletal Muscle Relaxants for Older Adults (2.16.840.1.113883.3.464.1003.1062): Added 1 RxNorm code (2627781) based on review by technical experts, SMEs, and/or public feedback. Deleted 1 RxNorm code (197945) based on review by technical experts, SMEs, and/or public feedback.
Measure Section:
Terminology
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Measure Lead
Value set Palliative Care Encounter (2.16.840.1.113883.3.464.1003.101.12.1090): 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 (2.16.840.1.114222.4.11.3591): Renamed to Payer Type based on recommended value set naming conventions.
Measure Section:
Terminology
Source of Change:
Annual Update
Value set (2.16.840.1.113883.3.464.1003.1054): Renamed to Potentially Harmful Antidepressants for Older Adults based on recommended value set naming conventions.
Measure Section:
Terminology
Source of Change:
Annual Update
Value set (2.16.840.1.113883.3.464.1003.1043): Renamed to Potentially Harmful Antihistamines for Older Adults based on recommended value set naming conventions.
Measure Section:
Terminology
Source of Change:
Annual Update
Value set (2.16.840.1.113883.3.464.1003.196.12.1481): Renamed to Potentially Harmful Antiinfectives for Older Adults based on recommended value set naming conventions.
Measure Section:
Terminology
Source of Change:
Annual Update
Value set Potentially Harmful Antiinfectives for Older Adults (2.16.840.1.113883.3.464.1003.196.12.1481): Added 1 RxNorm code (422434) based on review by technical experts, SMEs, and/or public feedback.
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Terminology
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Measure Lead
Value set (2.16.840.1.113883.3.464.1003.1049): Renamed to Potentially Harmful Antiparkinsonian Agents for Older Adults based on recommended value set naming conventions.
Measure Section:
Terminology
Source of Change:
Annual Update
Value set (2.16.840.1.113883.3.464.1003.196.12.1523): Renamed to Potentially Harmful Antipsychotics for Older Adults based on recommended value set naming conventions.
Measure Section:
Terminology
Source of Change:
Annual Update
Value set Potentially Harmful Antipsychotics for Older Adults (2.16.840.1.113883.3.464.1003.196.12.1523): Added 9 RxNorm codes (2636033, 2636041, 2636043, 2636045, 2636047, 2636049, 2636051, 2636637, 2636645) based on review by technical experts, SMEs, and/or public feedback.
Measure Section:
Terminology
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Measure Lead
Value set (2.16.840.1.113883.3.464.1003.1055): Renamed to Potentially Harmful Barbiturates for Older Adults based on recommended value set naming conventions.
Measure Section:
Terminology
Source of Change:
Annual Update
Value set (2.16.840.1.113883.3.464.1003.196.12.1522): Renamed to Potentially Harmful Benzodiazepines for Older Adults based on recommended value set naming conventions.
Measure Section:
Terminology
Source of Change:
Annual Update
Value set (2.16.840.1.113883.3.464.1003.1058): Renamed to Potentially Harmful Estrogens for Older Adults based on recommended value set naming conventions.
Measure Section:
Terminology
Source of Change:
Annual Update
Value set Potentially Harmful Estrogens for Older Adults (2.16.840.1.113883.3.464.1003.1058): Added 1 RxNorm code (2632844) based on review by technical experts, SMEs, and/or public feedback.
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Terminology
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Measure Lead
Value set (2.16.840.1.113883.3.464.1003.1050): Renamed to Potentially Harmful Gastrointestinal Antispasmodics for Older Adults based on recommended value set naming conventions.
Measure Section:
Terminology
Source of Change:
Annual Update
Value set (2.16.840.1.113883.3.464.1003.196.12.1480): Renamed to Potentially Harmful Nonbenzodiazepine Hypnotics for Older Adults based on recommended value set naming conventions.
Measure Section:
Terminology
Source of Change:
Annual Update
Value set Potentially Harmful Nonbenzodiazepine Hypnotics for Older Adults (2.16.840.1.113883.3.464.1003.196.12.1480): Added 1 RxNorm code (2637353) based on review by technical experts, SMEs, and/or public feedback.
Measure Section:
Terminology
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Measure Lead
Value set (2.16.840.1.113883.3.464.1003.1063): Renamed to Potentially Harmful Pain Medications for Older Adults based on recommended value set naming conventions.
Measure Section:
Terminology
Source of Change:
Annual Update
Value set (2.16.840.1.113883.3.464.1003.1062): Renamed to Potentially Harmful Skeletal Muscle Relaxants for Older Adults based on recommended value set naming conventions.
Measure Section:
Terminology
Source of Change:
Annual Update
Value set (2.16.840.1.113883.3.464.1003.1059): Renamed to Potentially Harmful Sulfonylureas for Older Adults based on recommended value set naming conventions.
Measure Section:
Terminology
Source of Change:
Annual Update
Removed value set Reserpine (2.16.840.1.113883.3.464.1003.1044) based on review by technical experts, SMEs, and/or public feedback.
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Terminology
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Measure Lead
Value set Seizure Disorder (2.16.840.1.113883.3.464.1003.105.12.1206): Added 4 ICD-10-CM codes (G40.C01, G40.C09, G40.C11, G40.C19) based on review by technical experts, SMEs, and/or public feedback. Added 5 SNOMED CT codes (1231737000, 1237417007, 1237619001, 1254960008, 80651009) based on review by technical experts, SMEs, and/or public feedback. Deleted 13 SNOMED CT codes based on review by technical experts, SMEs, and/or public feedback.
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Terminology
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Measure Lead
Value set (2.16.840.1.113883.3.464.1003.101.12.1089): Renamed to Virtual Encounter based on recommended value set naming conventions.
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Terminology
Source of Change:
Annual Update
Removed direct reference code RxNorm code (1441565) based on review by technical experts, SMEs, and/or public feedback.
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Terminology
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Measure Lead
Removed direct reference code RxNorm code (198196) based on review by technical experts, SMEs, and/or public feedback.
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Terminology
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Measure Lead
Removed direct reference code RxNorm code (198197) based on review by technical experts, SMEs, and/or public feedback.
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Terminology
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Measure Lead