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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.

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

Compare 2025 version to

Table Options
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....

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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)....

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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...

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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...

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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...

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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...

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Numerator Exclusions

Not Applicable

Denominator Exceptions

None

Telehealth Eligible Yes
Next Version No Version Available
Previous Version

Header

  • Updated the eCQM version number.

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    eCQM Version Number

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    Annual Update

  • Changed all references from NQF to CBE to identify the consensus-based entity role.

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    CBE Number

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    Annual Update

  • Updated copyright.

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    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

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    Measure Lead

  • Updated language to account for updated drug lists based upon recommendations in the 2023 American Geriatrics Society Beers Criteria.

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    Reference

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  • Updated grammar, wording, and/or formatting to improve readability and consistency.

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    Annual Update

  • Updated references and measure header to reflect current evidence and new or updated literature.

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Logic

  • Updated the version number of the Palliative Care Exclusion Library to v4.0.000 and the library name from 'PalliativeCareExclusionECQM' to 'PalliativeCareQDM.'

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  • 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.'

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    Definitions

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    Annual Update

  • Updated the version number of the Hospice Library to v6.0.000 and the library name from 'Hospice' to 'HospiceQDM.'

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    Annual Update

  • Renamed value set to 'Payer Type' to more accurately reflect the contents and intent of the value set.

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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.'

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  • Updated the value set name for 'Online Assessments' to 'Virtual Encounter' for a more accurate description.

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  • 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.'

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    Functions

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    Annual Update

  • Updated the following functions to account for updated drug lists based upon recommendations in the 2023 American Geriatrics Society Beers Criteria: 'MedicationStrengthPerUnit.'

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    Functions

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  • Updated the version number of the Cumulative Medication Duration Library to v3.0.000 and the library name from 'CumulativeMedicationDuration' to 'CumulativeMedicationDurationQDM.'

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    Functions

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    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.

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    Terminology

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  • 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.

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  • 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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  • 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.

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  • 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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  • 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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  • 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.

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    Terminology

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    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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  • 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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  • 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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  • 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.

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  • 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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  • 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.

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    Terminology

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    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.

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    Terminology

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    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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  • Value set (2.16.840.1.113883.3.464.1003.1065): Renamed to Digoxin Medications based on recommended value set naming conventions.

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  • Value set (2.16.840.1.113883.3.464.1003.1051): Renamed to Dipyridamole Medications based on recommended value set naming conventions.

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  • Value set (2.16.840.1.113883.3.464.1003.1067): Renamed to Doxepin Medications based on recommended value set naming conventions.

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    Terminology

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    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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  • 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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  • 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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  • 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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  • 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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  • 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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  • 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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  • 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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  • Value set (2.16.840.1.113883.3.464.1003.1057): Renamed to Meprobamate Medications based on recommended value set naming conventions.

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    Terminology

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    Annual Update

  • Value set (2.16.840.1.113883.3.464.1003.1053): Renamed to Nifedipine Medications based on recommended value set naming conventions.

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    Terminology

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    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.

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  • 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.

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  • 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.

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  • 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.

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  • 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.

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  • 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.

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  • Value set (2.16.840.1.114222.4.11.3591): Renamed to Payer Type based on recommended value set naming conventions.

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    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.

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    Terminology

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    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.

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    Terminology

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    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.

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  • 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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  • 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.

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  • 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.

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  • 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.

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  • 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.

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    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.

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  • 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.

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  • 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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  • 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.

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  • 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.

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  • 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.

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  • 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.

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  • 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.

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  • 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.

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  • 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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  • 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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  • 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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  • Removed direct reference code RxNorm code (1441565) based on review by technical experts, SMEs, and/or public feedback.

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  • Removed direct reference code RxNorm code (198196) based on review by technical experts, SMEs, and/or public feedback.

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  • Removed direct reference code RxNorm code (198197) based on review by technical experts, SMEs, and/or public feedback.

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Last Updated: Aug 01, 2024