Diabetes: Eye Exam

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Measure Information	2023 Performance Period	2024 Performance Period	2025 Performance Period	2026 Performance Period
Title	Diabetes: Eye Exam	Diabetes: Eye Exam	Diabetes: Eye Exam	Diabetes: Eye Exam
CMS eCQM ID	CMS131v11	CMS131v12	CMS131v13	CMS131v14
CBE ID*	Not Applicable	Not Applicable	Not Applicable	Not Applicable
MIPS Quality ID	117	117	117	117
Measure Steward	National Committee for Quality Assurance	National Committee for Quality Assurance	National Committee for Quality Assurance	National Committee for Quality Assurance
Description	Percentage of patients 18-75 years of age with diabetes and an active diagnosis of retinopathy in any part of the measurement period who had a retinal or dilated eye exam by an eye care professional during the measurement period or diabetics with no diagnosis of retinopathy in any part... of the measurement period who had a retinal or dilated eye exam by an eye care professional during the measurement period or in the 12 months prior to the measurement period Show more > Percentage of patients 18-75 years of age with diabetes and an active diagnosis of retinopathy in any part of the measurement period who had a retinal or dilated eye exam by an eye care professional during the measurement period or diabetics with no diagnosis of retinopathy in any part of the measurement period who had a retinal or dilated eye exam by an eye care professional during the measurement period or in the 12 months prior to the measurement period Show less	Percentage of patients 18-75 years of age with diabetes and an active diagnosis of retinopathy in any part of the measurement period who had a retinal or dilated eye exam by an eye care professional during the measurement period or diabetics with no diagnosis of retinopathy in any part... of the measurement period who had a retinal or dilated eye exam by an eye care professional during the measurement period or in the 12 months prior to the measurement period Show more > Percentage of patients 18-75 years of age with diabetes and an active diagnosis of retinopathy in any part of the measurement period who had a retinal or dilated eye exam by an eye care professional during the measurement period or diabetics with no diagnosis of retinopathy in any part of the measurement period who had a retinal or dilated eye exam by an eye care professional during the measurement period or in the 12 months prior to the measurement period Show less	Percentage of patients 18-75 years of age with diabetes and an active diagnosis of retinopathy in any part of the measurement period who had a retinal or dilated eye exam by an eye care professional during the measurement period or diabetics with no diagnosis of retinopathy in any part... of the measurement period who had a retinal or dilated eye exam by an eye care professional during the measurement period or in the 12 months prior to the measurement period Show more > Percentage of patients 18-75 years of age with diabetes and an active diagnosis of retinopathy in any part of the measurement period who had a retinal or dilated eye exam by an eye care professional during the measurement period or diabetics with no diagnosis of retinopathy in any part of the measurement period who had a retinal or dilated eye exam by an eye care professional during the measurement period or in the 12 months prior to the measurement period Show less	Percentage of patients 18-75 years of age with diabetes and an active diagnosis of retinopathy in any part of the measurement period who had a retinal or dilated eye exam by an eye care professional during the measurement period or diabetics with no diagnosis of retinopathy in any part... of the measurement period who had a retinal or dilated eye exam by an eye care professional during the measurement period or in the 12 months prior to the measurement period Show more > Percentage of patients 18-75 years of age with diabetes and an active diagnosis of retinopathy in any part of the measurement period who had a retinal or dilated eye exam by an eye care professional during the measurement period or diabetics with no diagnosis of retinopathy in any part of the measurement period who had a retinal or dilated eye exam by an eye care professional during the measurement period or in the 12 months prior to the measurement period Show less
Measure Scoring	Proportion measure	Proportion measure	Proportion measure	Proportion measure
Measure Type	Process	Process	Process	Process
Stratification	*See CMS131v11.html	None	None	None
Risk Adjustment	*See CMS131v11.html	None	None	None
Rationale	*See CMS131v11.html	Diabetes is the seventh leading cause of death in the United States (Centers for Disease Control and Prevention [CDC], 2022a). In 2019, diabetes affected more than 37 million Americans (11.3 percent of the U.S. population) and killed more than 87,000 people (American Diabetes Association... [ADA], 2022a). Diabetes is a long-lasting disease marked by high blood glucose levels, resulting from the body's inability to produce or use insulin properly (CDC, 2022a). People with diabetes are at increased risk of serious health complications including vision loss, heart disease, stroke, kidney damage, amputation of feet or legs, and premature death (CDC, 2022b). In 2017, diabetes cost the U.S. an estimated $327 billion: $237 billion in direct medical costs and $90 billion in reduced productivity. This is a 34 percent increase from the estimated $245 billion spent on diabetes in 2012 (ADA, 2018). Diabetic retinopathy is progressive damage to the small blood vessels in the retina that may result in loss of vision. It is the leading cause of blindness in adults between 20-74 years of age. Approximately 4.1 million adults are affected by diabetic retinopathy (CDC, 2020). Show more > Diabetes is the seventh leading cause of death in the United States (Centers for Disease Control and Prevention [CDC], 2022a). In 2019, diabetes affected more than 37 million Americans (11.3 percent of the U.S. population) and killed more than 87,000 people (American Diabetes Association [ADA], 2022a). Diabetes is a long-lasting disease marked by high blood glucose levels, resulting from the body's inability to produce or use insulin properly (CDC, 2022a). People with diabetes are at increased risk of serious health complications including vision loss, heart disease, stroke, kidney damage, amputation of feet or legs, and premature death (CDC, 2022b). In 2017, diabetes cost the U.S. an estimated $327 billion: $237 billion in direct medical costs and $90 billion in reduced productivity. This is a 34 percent increase from the estimated $245 billion spent on diabetes in 2012 (ADA, 2018). Diabetic retinopathy is progressive damage to the small blood vessels in the retina that may result in loss of vision. It is the leading cause of blindness in adults between 20-74 years of age. Approximately 4.1 million adults are affected by diabetic retinopathy (CDC, 2020). Show less	Diabetes is the seventh leading cause of death in the United States (Centers for Disease Control and Prevention [CDC], 2022a). In 2019, diabetes affected more than 37 million Americans (11.3 percent of the U.S. population) and killed more than 87,000 people (American Diabetes Association... [ADA], 2022a). Diabetes is a long-lasting disease marked by high blood glucose levels, resulting from the body's inability to produce or use insulin properly (CDC, 2022a). People with diabetes are at increased risk of serious health complications including vision loss, heart disease, stroke, kidney damage, amputation of feet or legs, and premature death (CDC, 2022b). In 2017, diabetes cost the U.S. an estimated $327 billion: $237 billion in direct medical costs and $90 billion in reduced productivity. This is a 34 percent increase from the estimated $245 billion spent on diabetes in 2012 (ADA, 2018). Diabetic retinopathy is progressive damage to the small blood vessels in the retina that may result in loss of vision. It is the leading cause of blindness in adults between 20-74 years of age. Approximately 4.1 million adults are affected by diabetic retinopathy (CDC, 2020). Show more > Diabetes is the seventh leading cause of death in the United States (Centers for Disease Control and Prevention [CDC], 2022a). In 2019, diabetes affected more than 37 million Americans (11.3 percent of the U.S. population) and killed more than 87,000 people (American Diabetes Association [ADA], 2022a). Diabetes is a long-lasting disease marked by high blood glucose levels, resulting from the body's inability to produce or use insulin properly (CDC, 2022a). People with diabetes are at increased risk of serious health complications including vision loss, heart disease, stroke, kidney damage, amputation of feet or legs, and premature death (CDC, 2022b). In 2017, diabetes cost the U.S. an estimated $327 billion: $237 billion in direct medical costs and $90 billion in reduced productivity. This is a 34 percent increase from the estimated $245 billion spent on diabetes in 2012 (ADA, 2018). Diabetic retinopathy is progressive damage to the small blood vessels in the retina that may result in loss of vision. It is the leading cause of blindness in adults between 20-74 years of age. Approximately 4.1 million adults are affected by diabetic retinopathy (CDC, 2020). Show less	Diabetes is the eighth leading cause of death in the United States. In 2021, diabetes affected more than 38 million Americans (11.6 percent of the U.S. population) and killed more than 103,000 people (American Diabetes Association [ADA], 2024). Diabetes is a long-lasting disease marked... by high blood glucose levels, resulting from the body's inability to produce or use insulin properly (Centers for Disease Control and Prevention [CDC], 2022a). People with diabetes are at increased risk of serious health complications including vision loss, heart disease, stroke, kidney damage, amputation of feet or legs, and premature death (CDC, 2022b). In 2022, diabetes cost the U.S. an estimated $413 billion: $307 billion in direct medical costs and $106 billion in reduced productivity. The direct medical cost of diabetes increased by 7% between 2017 and 2022 (Parker et al., 2022). Diabetes is the leading cause of new cases of blindness among adults aged 18–64 years (CDC, 2024). Diabetic retinopathy is progressive damage to the small blood vessels in the retina that may result in loss of vision. Approximately 4.1 million adults are affected by diabetic retinopathy (CDC, 2020). Show more > Diabetes is the eighth leading cause of death in the United States. In 2021, diabetes affected more than 38 million Americans (11.6 percent of the U.S. population) and killed more than 103,000 people (American Diabetes Association [ADA], 2024). Diabetes is a long-lasting disease marked by high blood glucose levels, resulting from the body's inability to produce or use insulin properly (Centers for Disease Control and Prevention [CDC], 2022a). People with diabetes are at increased risk of serious health complications including vision loss, heart disease, stroke, kidney damage, amputation of feet or legs, and premature death (CDC, 2022b). In 2022, diabetes cost the U.S. an estimated $413 billion: $307 billion in direct medical costs and $106 billion in reduced productivity. The direct medical cost of diabetes increased by 7% between 2017 and 2022 (Parker et al., 2022). Diabetes is the leading cause of new cases of blindness among adults aged 18–64 years (CDC, 2024). Diabetic retinopathy is progressive damage to the small blood vessels in the retina that may result in loss of vision. Approximately 4.1 million adults are affected by diabetic retinopathy (CDC, 2020). Show less
Clinical Recommendation Statement	*See CMS131v11.html	American Diabetes Association (2022b): - Adults with type 1 diabetes should have an initial dilated and comprehensive eye examination by an ophthalmologist or optometrist within 5 years after the onset of diabetes. (Level of evidence: B) - Patients with type 2 diabetes should have an... initial dilated and comprehensive eye examination by an ophthalmologist or optometrist at the time of the diabetes diagnosis. (Level of evidence: B) - If there is no evidence of retinopathy for one or more annual eye exam and glycemia is well controlled, then screening every 1–2 years may be considered. If any level of diabetic retinopathy is present, subsequent dilated retinal examinations should be repeated at least annually by an ophthalmologist or optometrist. If retinopathy is progressing or sight threatening, then examinations will be required more frequently. (Level of evidence: B) Show more > American Diabetes Association (2022b): - Adults with type 1 diabetes should have an initial dilated and comprehensive eye examination by an ophthalmologist or optometrist within 5 years after the onset of diabetes. (Level of evidence: B) - Patients with type 2 diabetes should have an initial dilated and comprehensive eye examination by an ophthalmologist or optometrist at the time of the diabetes diagnosis. (Level of evidence: B) - If there is no evidence of retinopathy for one or more annual eye exam and glycemia is well controlled, then screening every 1–2 years may be considered. If any level of diabetic retinopathy is present, subsequent dilated retinal examinations should be repeated at least annually by an ophthalmologist or optometrist. If retinopathy is progressing or sight threatening, then examinations will be required more frequently. (Level of evidence: B) Show less	American Diabetes Association (2023): - Adults with type 1 diabetes should have an initial dilated and comprehensive eye examination by an ophthalmologist or optometrist within 5 years after the onset of diabetes. (Level of evidence: B) - Patients with type 2 diabetes should have an... initial dilated and comprehensive eye examination by an ophthalmologist or optometrist at the time of the diabetes diagnosis. (Level of evidence: B) - If there is no evidence of retinopathy for one or more annual eye exams and glycemia is well controlled, then screening every 1–2 years may be considered. If any level of diabetic retinopathy is present, subsequent dilated retinal examinations should be repeated at least annually by an ophthalmologist or optometrist. If retinopathy is progressing or sight threatening, then examinations will be required more frequently. (Level of evidence: B) Show more > American Diabetes Association (2023): - Adults with type 1 diabetes should have an initial dilated and comprehensive eye examination by an ophthalmologist or optometrist within 5 years after the onset of diabetes. (Level of evidence: B) - Patients with type 2 diabetes should have an initial dilated and comprehensive eye examination by an ophthalmologist or optometrist at the time of the diabetes diagnosis. (Level of evidence: B) - If there is no evidence of retinopathy for one or more annual eye exams and glycemia is well controlled, then screening every 1–2 years may be considered. If any level of diabetic retinopathy is present, subsequent dilated retinal examinations should be repeated at least annually by an ophthalmologist or optometrist. If retinopathy is progressing or sight threatening, then examinations will be required more frequently. (Level of evidence: B) Show less	American Diabetes Association (2024): - Adults with type 1 diabetes should have an initial dilated and comprehensive eye examination by an ophthalmologist or optometrist within 5 years after the onset of diabetes. (Level of evidence: B) - Patients with type 2 diabetes should have an... initial dilated and comprehensive eye examination by an ophthalmologist or optometrist at the time of the diabetes diagnosis. (Level of evidence: B) - If there is no evidence of retinopathy for one or more annual eye exams and glycemia is well controlled, then screening every 1–2 years may be considered. If any level of diabetic retinopathy is present, subsequent dilated retinal examinations should be repeated at least annually by an ophthalmologist or optometrist. If retinopathy is progressing or sight threatening, then examinations will be required more frequently. (Level of evidence: B) Show more > American Diabetes Association (2024): - Adults with type 1 diabetes should have an initial dilated and comprehensive eye examination by an ophthalmologist or optometrist within 5 years after the onset of diabetes. (Level of evidence: B) - Patients with type 2 diabetes should have an initial dilated and comprehensive eye examination by an ophthalmologist or optometrist at the time of the diabetes diagnosis. (Level of evidence: B) - If there is no evidence of retinopathy for one or more annual eye exams and glycemia is well controlled, then screening every 1–2 years may be considered. If any level of diabetic retinopathy is present, subsequent dilated retinal examinations should be repeated at least annually by an ophthalmologist or optometrist. If retinopathy is progressing or sight threatening, then examinations will be required more frequently. (Level of evidence: B) Show less
Improvement Notation	Higher score indicates better quality	Higher score indicates better quality	Higher score indicates better quality	Higher score indicates better quality
Definition	*See CMS131v11.html	None	None	None
Guidance	The eye exam must be performed by an ophthalmologist or optometrist, or there must be evidence that fundus photography results were read by a system that provides an artificial intelligence (AI) interpretation. This eCQM is a patient-based measure. This version of the eCQM uses QDM... version 5.6. Please refer to the QDM page for more information on the QDM. Show more > The eye exam must be performed by an ophthalmologist or optometrist, or there must be evidence that fundus photography results were read by a system that provides an artificial intelligence (AI) interpretation. This eCQM is a patient-based measure. This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM. Show less	The eye exam must be performed by an ophthalmologist or optometrist, or there must be evidence that fundus photography results were read by a system that provides an artificial intelligence (AI) interpretation. This eCQM is a patient-based measure. This version of the eCQM uses QDM... version 5.6. Please refer to the QDM page for more information on the QDM. Show more > The eye exam must be performed by an ophthalmologist or optometrist, or there must be evidence that fundus photography results were read by a system that provides an artificial intelligence (AI) interpretation. This eCQM is a patient-based measure. This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM. Show less	The eye exam must be performed by an ophthalmologist or optometrist, or there must be evidence that fundus photography results were read by a system that provides an artificial intelligence (AI) interpretation. This eCQM is a patient-based measure. This version of the eCQM uses QDM... version 5.6. Please refer to the QDM page for more information on the QDM. Show more > The eye exam must be performed by an ophthalmologist or optometrist, or there must be evidence that fundus photography results were read by a system that provides an artificial intelligence (AI) interpretation. This eCQM is a patient-based measure. This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM. Show less	The eye exam must be performed by an ophthalmologist or optometrist, or there must be evidence that fundus photography results were analyzed by a system that provides an autonomous artificial intelligence (AI) calculation. This eCQM is a patient-based measure. This version of the eCQM... uses QDM version 5.6. Please refer to the QDM page for more information on the QDM. Show more > The eye exam must be performed by an ophthalmologist or optometrist, or there must be evidence that fundus photography results were analyzed by a system that provides an autonomous artificial intelligence (AI) calculation. This eCQM is a patient-based measure. This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM. Show less
Initial Population	Patients 18-75 years of age by the end of the measurement period, with diabetes with a visit during the measurement period	Patients 18-75 years of age by the end of the measurement period, with diabetes with a visit during the measurement period	Patients 18-75 years of age by the end of the measurement period, with diabetes with a visit during the measurement period	Patients 18-75 years of age by the end of the measurement period, with diabetes with a visit during the measurement period
Denominator	Equals Initial Population	Equals Initial Population	Equals Initial Population	Equals Initial Population
Denominator Exclusions	Exclude patients who are in hospice care for any part of the measurement period. Exclude patients 66 and older by the end of the measurement period who are living long term in a nursing home any time on or before the end of the measurement period. Exclude patients 66 and older by the end... of the measurement period with an indication of frailty for any part of the measurement period who also meet any of the following advanced illness criteria: - Advanced illness with two outpatient encounters during the measurement period or the year prior - OR advanced illness with one inpatient encounter during the measurement period or the year prior - OR taking dementia medications during the measurement period or the year prior Exclude patients receiving palliative care for any part of the measurement period. Show more > Exclude patients who are in hospice care for any part of the measurement period. Exclude patients 66 and older by the end of the measurement period who are living long term in a nursing home any time on or before the end of the measurement period. Exclude patients 66 and older by the end of the measurement period with an indication of frailty for any part of the measurement period who also meet any of the following advanced illness criteria: - Advanced illness with two outpatient encounters during the measurement period or the year prior - OR advanced illness with one inpatient encounter during the measurement period or the year prior - OR taking dementia medications during the measurement period or the year prior Exclude patients receiving palliative care for any part of the measurement period. Show less	Exclude patients who are in hospice care for any part of the measurement period. Exclude patients 66 and older by the end of the measurement period who are living long term in a nursing home any time on or before the end of the measurement period. Exclude patients 66 and older by the end... of the measurement period with an indication of frailty for any part of the measurement period who also meet any of the following advanced illness criteria: - Advanced illness with two outpatient encounters during the measurement period or the year prior - OR advanced illness with one inpatient encounter during the measurement period or the year prior - OR taking dementia medications during the measurement period or the year prior Exclude patients receiving palliative care for any part of the measurement period. Show more > Exclude patients who are in hospice care for any part of the measurement period. Exclude patients 66 and older by the end of the measurement period who are living long term in a nursing home any time on or before the end of the measurement period. Exclude patients 66 and older by the end of the measurement period with an indication of frailty for any part of the measurement period who also meet any of the following advanced illness criteria: - Advanced illness with two outpatient encounters during the measurement period or the year prior - OR advanced illness with one inpatient encounter during the measurement period or the year prior - OR taking dementia medications during the measurement period or the year prior Exclude patients receiving palliative care for any part of the measurement period. Show less	Exclude patients who are in hospice care for any part of the measurement period. Exclude patients 66 and older by the end of the measurement period with an indication of frailty for any part of the measurement period who also meet any of the following advanced illness criteria: - Advanced... illness diagnosis during the measurement period or the year prior - OR taking dementia medications during the measurement period or the year prior Exclude patients 66 and older by the end of the measurement period who are living long term in a nursing home any time on or before the end of the measurement period. Exclude patients receiving palliative care for any part of the measurement period. Show more > Exclude patients who are in hospice care for any part of the measurement period. Exclude patients 66 and older by the end of the measurement period with an indication of frailty for any part of the measurement period who also meet any of the following advanced illness criteria: - Advanced illness diagnosis during the measurement period or the year prior - OR taking dementia medications during the measurement period or the year prior Exclude patients 66 and older by the end of the measurement period who are living long term in a nursing home any time on or before the end of the measurement period. Exclude patients receiving palliative care for any part of the measurement period. Show less	Exclude patients who are in hospice care for any part of the measurement period. Exclude patients 66 and older by the end of the measurement period with an indication of frailty for any part of the measurement period who also meet any of the following advanced illness criteria: - Advanced... illness diagnosis during the measurement period or the year prior - OR taking dementia medications during the measurement period or the year prior Exclude patients 66 and older by the end of the measurement period who are living long term in a nursing home any time on or before the end of the measurement period. Exclude patients receiving palliative care for any part of the measurement period. Exclude patients who have bilateral absence of eyes any time during the patient’s history through the end of the measurement period. Show more > Exclude patients who are in hospice care for any part of the measurement period. Exclude patients 66 and older by the end of the measurement period with an indication of frailty for any part of the measurement period who also meet any of the following advanced illness criteria: - Advanced illness diagnosis during the measurement period or the year prior - OR taking dementia medications during the measurement period or the year prior Exclude patients 66 and older by the end of the measurement period who are living long term in a nursing home any time on or before the end of the measurement period. Exclude patients receiving palliative care for any part of the measurement period. Exclude patients who have bilateral absence of eyes any time during the patient’s history through the end of the measurement period. Show less
Numerator	Patients with an eye screening for diabetic retinal disease. This includes diabetics who had one of the following: •Diabetic with a diagnosis of retinopathy in any part of the measurement period and a retinal or dilated eye exam by an eye care professional in the measurement period •Diabet... ic with no diagnosis of retinopathy in any part of the measurement period and a retinal or dilated eye exam by an eye care professional in the measurement period or the year prior to the measurement period Show more > Patients with an eye screening for diabetic retinal disease. This includes diabetics who had one of the following: •Diabetic with a diagnosis of retinopathy in any part of the measurement period and a retinal or dilated eye exam by an eye care professional in the measurement period •Diabetic with no diagnosis of retinopathy in any part of the measurement period and a retinal or dilated eye exam by an eye care professional in the measurement period or the year prior to the measurement period Show less	Patients with an eye screening for diabetic retinal disease. This includes diabetics who had one of the following: - Diabetic with a diagnosis of retinopathy in any part of the measurement period and a retinal or dilated eye exam by an eye care professional in the measurement period -... Diabetic with no diagnosis of retinopathy in any part of the measurement period and a retinal or dilated eye exam by an eye care professional in the measurement period or the year prior to the measurement period Show more > Patients with an eye screening for diabetic retinal disease. This includes diabetics who had one of the following: - Diabetic with a diagnosis of retinopathy in any part of the measurement period and a retinal or dilated eye exam by an eye care professional in the measurement period - Diabetic with no diagnosis of retinopathy in any part of the measurement period and a retinal or dilated eye exam by an eye care professional in the measurement period or the year prior to the measurement period Show less	Patients with an eye screening for diabetic retinal disease. This includes diabetics who had one of the following: - Diabetic with a diagnosis of retinopathy in any part of the measurement period and a retinal or dilated eye exam by an eye care professional in the measurement period -... Diabetic with no diagnosis of retinopathy in any part of the measurement period and a retinal or dilated eye exam by an eye care professional in the measurement period or the year prior to the measurement period Show more > Patients with an eye screening for diabetic retinal disease. This includes diabetics who had one of the following: - Diabetic with a diagnosis of retinopathy in any part of the measurement period and a retinal or dilated eye exam by an eye care professional in the measurement period - Diabetic with no diagnosis of retinopathy in any part of the measurement period and a retinal or dilated eye exam by an eye care professional in the measurement period or the year prior to the measurement period Show less	Patients with an eye screening for diabetic retinal disease. This includes patients with diabetes who had one of the following: - A diagnosis of retinopathy in any part of the measurement period and a retinal or dilated eye exam by an eye care professional in the measurement period - No... diagnosis of retinopathy in any part of the measurement period and a retinal or dilated eye exam by an eye care professional in the measurement period or the year prior to the measurement period - An autonomous eye exam in the measurement period - A retinal exam finding with a retinopathy severity level in any part of the measurement period - A retinal exam finding with no retinopathy severity level in the year prior to the measurement period Show more > Patients with an eye screening for diabetic retinal disease. This includes patients with diabetes who had one of the following: - A diagnosis of retinopathy in any part of the measurement period and a retinal or dilated eye exam by an eye care professional in the measurement period - No diagnosis of retinopathy in any part of the measurement period and a retinal or dilated eye exam by an eye care professional in the measurement period or the year prior to the measurement period - An autonomous eye exam in the measurement period - A retinal exam finding with a retinopathy severity level in any part of the measurement period - A retinal exam finding with no retinopathy severity level in the year prior to the measurement period Show less
Numerator Exclusions	Not Applicable	Not Applicable	Not Applicable	None
Denominator Exceptions	None	None	None	None
Telehealth Eligible	Yes	Yes	Yes	Yes
Next Version	CMS131v12	CMS131v13	CMS131v14	No Version Available
Previous Version	No Version Available	CMS131v11	CMS131v12	CMS131v13

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Specifications

Additional Resources for CMS131v14

CMS131-v14.0.000-TRN.xlsx

Header

TRN	Measure Section	Source of Change
Changed the 'eCQM Identifier (Measure Authoring Tool)' field name to 'CMS ID' based on tooling updates.	CMS ID	Standards/Technical Update
Updated the eCQM version number.	eCQM Version Number	Annual Update
Updated the generic measurement period from 'January 1, 20XX through December 31, 20XX' to specify 'January 1, 2026 through December 31, 2026' based on tooling updates.	Measurement Period	Standards/Technical Update
Updated copyright.	Copyright	Annual Update
Updated rationale to reflect new literature regarding prevalence and cost associated with diabetes treatment.	Rationale	Measure Lead
Updated references and measure header to reflect current evidence and new or updated literature.	Multiple Sections	Measure Lead
Revised the guidance statement in the measure header to incorporate eye exams analyzed by artificial intelligence (AI) interpretation as advised by clinical experts.	Guidance	Measure Lead
Added denominator exclusion criteria to exclude patients who have bilateral absence of eyes any time during the patient’s history through the end of the measurement period.	Denominator Exclusions	Measure Lead
Added numerator criteria to include an autonomous eye exam in the measurement period, a retinal exam finding with retinopathy severity level in the measurement period, and a retinal exam finding without retinopathy severity level in the year prior to the measurement period.	Numerator	Measure Lead
Changed 'Numerator Exclusions' field to read 'None' instead of 'Not Applicable' when no exclusions are present.	Numerator Exclusions	Standards/Technical Update
Updated grammar, wording, and/or formatting to improve readability and consistency.	Multiple Sections	Annual Update

Logic

TRN	Measure Section	Source of Change
Updated Measure Primary CQL Library Name from 'DiabetesEyeExam' to 'CMS131DiabetesEyeExam' for alignment with the CQL Style Guide.	Definitions	Standards/Technical Update
Updated the version number of the Global Common Functions Library to 9.0.000 and the library name from 'MATGlobalCommonFunctionsQDM' to 'CQMCommonQDM.'	Definitions	Annual Update
Updated the version number of the AdvancedIllnessandFrailtyQDM library to 10.0.000.	Definitions	Annual Update
Updated the version number of the HospiceQDM library to 7.0.000.	Definitions	Annual Update
Updated the version number of the PalliativeCareQDM library to 5.0.000.	Definitions	Annual Update
Added denominator exclusion criteria to exclude patients who have bilateral absence of eyes any time during the patient’s history through the end of the measurement period.	Definitions	Measure Lead
Added numerator criteria to include an autonomous eye exam in the measurement period, a retinal exam finding with retinopathy severity level in the measurement period, and a retinal exam finding without retinopathy severity level in the year prior to the measurement period.	Definitions	Measure Lead
Updated the names of CQL definitions, functions, and/or aliases for clarification and to align with the CQL Style Guide.	Definitions	Standards/Technical Update
Updated Measure Primary CQL Library Name from 'DiabetesEyeExam' to 'CMS131DiabetesEyeExam' for alignment with the CQL Style Guide.	Functions	Standards/Technical Update
Updated the version number of the Global Common Functions Library to 9.0.000 and the library name from 'MATGlobalCommonFunctionsQDM' to 'CQMCommonQDM.'	Functions	Annual Update
Updated the version number of the AdvancedIllnessandFrailtyQDM library to 10.0.000.	Functions	Annual Update
Updated the version number of the HospiceQDM library to 7.0.000.	Functions	Annual Update
Updated the version number of the PalliativeCareQDM library to 5.0.000.	Functions	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.

TRN	Measure Section	Source of Change
Added Direct Reference Code 'Anophthalmos of bilateral eyes (disorder)' (SNOMEDCT Code 15665641000119103) based on review by technical experts, SMEs and/or public feedback.	Terminology	Annual Update
Added Direct Reference Code 'Eye Diabetic retinopathy screening Autonomous artificial intelligence' (LOINC Code 105914-6) based on review by technical experts, SMEs and/or public feedback.	Terminology	Annual Update
Added Direct Reference Code 'Left eye Diabetic retinopathy severity level by Ophthalmoscopy' (LOINC Code 71490-7) based on review by technical experts, SMEs and/or public feedback.	Terminology	Annual Update
Added Direct Reference Code 'No apparent retinopathy' (LOINC Code LA18643-9) based on review by technical experts, SMEs and/or public feedback.	Terminology	Annual Update
Added Direct Reference Code 'Right eye Diabetic retinopathy severity level by Ophthalmoscopy' (LOINC Code 71491-5) based on review by technical experts, SMEs and/or public feedback.	Terminology	Annual Update
Value Set 'Advanced Illness' (2.16.840.1.113883.3.464.1003.110.12.1082): Deleted 1 ICD10CM code (G20) based on review by technical experts, SMEs and/or public feedback. Added 356 SNOMEDCT codes (113901000052102, 1236931008, 1236940007, 1236941006, 1236942004, 1236943009, 1236944003, 1236945002, 1236947005, 1236948000, 1236953005, 1236954004, 1236955003, 1236956002, 1236957006, 1236958001, 1236960004, 1236961000, 1236962007, 1236963002, 1236964008, 1236966005, 1236967001, 1236968006, 1236969003, 1237031003, 1237032005, 1237033000, 1237034006, 1237035007, 1237036008, 1237037004, 1237038009, 1237039001, 1237041000, 1237042007, 1237043002, 1237044008, 1237045009, 1237046005, 1237047001, 1237048006, 1237050003, 1237051004, 1237052006, 1237053001, 1237055008, 1237056009, 1237057000, 1237372005, 1237414000, 1237415004, 1237416003, 1237422007, 1237423002, 1237424008, 1237425009, 1237426005, 1237427001, 1237428006, 1237454003, 1237455002, 1237456001, 1237457005, 1237458000, 1237460003, 1237461004, 1237465008, 1237466009, 1237467000, 1237469002, 1237471002, 1237472009, 1237473004, 1237474005, 1237476007, 1237477003, 1237478008, 1237479000, 1237480002, 1237481003, 1237482005, 1237483000, 1237484006, 1237485007, 1237487004, 1237488009, 1237489001, 1237490005, 1237492002, 1237493007, 1237494001, 1237495000, 1237496004, 1237497008, 1237498003, 1237516000, 1237517009, 1237518004, 1237519007, 1237520001, 1237521002, 1237522009, 1237523004, 1237524005, 1237525006, 1237526007, 1237527003, 1237528008, 1237529000, 1237530005, 1237531009, 1237621006, 1240346000, 1240351006, 1240352004, 1240353009, 1240355002, 1240359008, 1240362006, 1240363001, 1240370001, 1240372009, 1251445000, 1251454002, 1251456000, 1251457009, 1251458004, 1251459007, 1251460002, 1251465007, 1251466008, 1251467004, 1251468009, 1251469001, 1251470000, 1251471001, 1251472008, 1251473003, 1251474009, 1251475005, 1251482009, 1251483004, 1251484005, 1251485006, 1251486007, 1251487003, 1251489000, 1251490009, 1251491008, 1251492001, 1251493006, 1251494000, 1251495004, 1251496003, 1251497007, 1251498002, 1254689008, 1254691000, 1254723004, 1254724005, 1254725006, 1254726007, 1254727003, 1254728008, 1254732002, 1254733007, 1254734001, 1254735000, 1254740008, 1254745003, 1254746002, 1254747006, 1254748001, 1254749009, 1254750009, 1254752001, 1254753006, 1254755004, 1259465009, 1259467001, 1259469003, 1259471003, 1259473000, 1259476008, 1259478009, 1259480003, 1259485008, 1259488005, 1259492003, 1259494002, 1259496000, 1259499007, 1259501004, 1259503001, 1259511006, 1259513009, 1259517005, 1259519008, 1259522005, 1259524006, 1259529001, 1259531005, 1259579003, 1259581001, 1259584009, 1259586006, 1259591007, 1259656006, 1259661008, 1259663006, 1259665004, 1259667007, 1259675001, 1259677009, 1259679007, 1259990004, 1263484004, 1263555006, 1263585001, 1263601000, 1263639008, 1263640005, 1263641009, 1263642002, 1263643007, 1263651005, 1263652003, 1263653008, 1263654002, 1263655001, 1263656000, 1263657009, 1263658004, 1263659007, 1263660002, 1263786003, 1263911005, 1263912003, 1263913008, 1263914002, 1263999008, 1264003007, 1264066001, 1264067005, 1264068000, 1264115008, 1264116009, 1264117000, 1264118005, 1264258003, 1264357006, 1264358001, 1264364008, 1264367001, 1264369003, 1264495000, 1264497008, 1264499006, 1264500002, 1264501003, 1264502005, 1268352008, 1268353003, 1268354009, 1268386004, 1268388003, 1268390002, 1268392005, 1268393000, 1268394006, 1268395007, 1268532006, 1268542008, 1268546006, 1268561007, 1268563005, 1268698000, 1268702001, 1268716006, 1268888008, 1268911008, 1268957005, 1268961004, 1268966009, 1269042005, 1269047004, 1269048009, 1269051002, 1269052009, 1269121005, 1269122003, 1269123008, 1269125001, 1269126000, 1279841001, 1279882001, 1286863002, 1286896000, 1286898004, 1287657002, 1287665004, 1290060007, 1290066001, 1290080008, 1290115008, 1290116009, 1290117000, 1290690001, 1290695006, 1290697003, 1290698008, 1290700004, 1296659009, 1296851009, 1306321008, 1306322001, 1306323006, 1306543004, 1306544005, 1306545006, 1306546007, 1306547003, 1332483008, 1332484002, 1332485001, 1332486000, 1335987009, 1336170004, 1336171000, 1336172007, 1336173002, 1336176005, 1336177001, 1336182008, 1336185005, 1336186006, 1336188007, 1336190008, 1339031006, 1339049006, 1339050006, 1339051005, 14914851000119109, 14914931000119107, 15650751000119107, 253005002, 255039001, 683771000119101, 683781000119103, 683801000119104, 684891000119108, 686421000119103, 687341000119100, 717919005, 724003651000119103) based on review by technical experts, SMEs and/or public feedback. Deleted 160 SNOMEDCT codes (1217692004, 13351431000119102, 16260631000119101, 1661000119106, 1691000119104, 233765002, 269616004, 285598005, 285603002, 285604008, 285605009, 285606005, 285607001, 285608006, 285609003, 285610008, 285611007, 285612000, 285613005, 285614004, 285615003, 285616002, 285617006, 285618001, 285619009, 285631006, 285633009, 285634003, 285635002, 285637005, 285638000, 285639008, 285640005, 285641009, 285642002, 285643007, 285644001, 285645000, 314987003, 314988008, 314989000, 314990009, 314991008, 314992001, 314993006, 314994000, 314995004, 314996003, 314997007, 314998002, 314999005, 315000005, 315001009, 315002002, 315003007, 315004001, 315005000, 315006004, 315007008, 315008003, 315009006, 369455009, 369456005, 369457001, 369458006, 369459003, 369460008, 369461007, 369464004, 369467006, 369468001, 369476004, 369477008, 369478003, 369479006, 369480009, 369481008, 369482001, 369484000, 369486003, 369491002, 369492009, 369500009, 369501008, 369502001, 369538008, 369540003, 369542006, 369543001, 369544007, 369545008, 369546009, 369553000, 369554006, 369555007, 369556008, 369557004, 369558009, 369560006, 369561005, 369562003, 369563008, 369564002, 369565001, 369568004, 369569007, 369570008, 369571007, 369572000, 369573005, 369574004, 369575003, 369576002, 369577006, 369578001, 369581006, 369582004, 369583009, 369584003, 369585002, 369586001, 369588000, 369589008, 369590004, 369591000, 369592007, 369593002, 369602008, 369603003, 369604009, 369605005, 369606006, 369607002, 369608007, 369609004, 369610009, 422782004, 423987006, 424887002, 434431000124103, 705176003, 712849003, 733185001, 781076008, 87101000119106, 94176003, 94177007, 94182000, 94244003, 94276008, 94277004, 94297009, 94385006, 94387003, 94401004, 94443006, 94444000, 94653000, 94655007, 96981000119102) based on review by technical experts, SMEs and/or public feedback.	Terminology	Annual Update
Added Value Set 'Autonomous Eye Exam Result or Finding' (2.16.840.1.113883.3.464.1004.2616) based on review by technical experts, SMEs and/or public feedback.	Terminology	Annual Update
Value Set 'Diabetes' (2.16.840.1.113883.3.464.1003.103.12.1001): Added 1 ICD10CM extensional value set (2.16.840.1.113883.3.464.1003.1272) based on review by technical experts, SMEs and/or public feedback. Deleted 3 ICD10 extensional value sets (2.16.840.1.113883.3.464.1003.103.11.1032, 2.16.840.1.113883.3.464.1003.103.11.1026, 2.16.840.1.113883.3.464.1003.103.11.1031) based on review by technical experts, SMEs and/or public feedback. Added 1 SNOMEDCT extensional value set (2.16.840.1.113883.3.464.1003.1273) based on review by technical experts, SMEs and/or public feedback. Deleted 2 SNOMEDCT extensional value sets (2.16.840.1.113883.3.464.1003.103.11.1027, 2.16.840.1.113883.3.464.1003.103.11.1030) based on review by technical experts, SMEs and/or public feedback.	Terminology	Annual Update
Value Set ‘Diabetic Retinopathy’ (2.16.840.1.113883.3.526.3.327): Added 2 SNOMEDCT codes (1306699009, 1306700005) based on code system/terminology updates.	Terminology	Annual Update
Added Value Set 'Diabetic Retinopathy Severity Level' (2.16.840.1.113883.3.464.1003.1266) based on review by technical experts, SMEs and/or public feedback.	Terminology	Annual Update
Value Set 'Frailty Diagnosis' (2.16.840.1.113883.3.464.1003.113.12.1074): Deleted 1 SNOMEDCT code (52702003) based on review by technical experts, SMEs and/or public feedback.	Terminology	Annual Update
Value Set 'Office Visit' (2.16.840.1.113883.3.464.1003.101.12.1001): Added 1 SNOMEDCT code (185349003) based on review by technical experts, SMEs and/or public feedback.	Terminology	Annual Update
Replaced Value Set 'ONC Administrative Sex' (2.16.840.1.113762.1.4.1) with Value Set 'Federal Administrative Sex' (2.16.840.1.113762.1.4.1021.121) to represent Supplemental Data Element 'SDE Sex' based on revised standards.	Terminology	Standards/Technical Update
Value Set 'Palliative Care Encounter' (2.16.840.1.113883.3.464.1003.101.12.1090): Deleted 1 HCPCS code (M1017) based on review by technical experts, SMEs and/or public feedback.	Terminology	Annual Update
Value Set 'Retinal or Dilated Eye Exam' (2.16.840.1.113883.3.464.1003.115.12.1088): Added 17 SNOMEDCT codes (36844005, 56204000, 410441007, 252846004, 56072006, 392005004, 700070005, 416369006, 3047001, 417587001, 391999003, 18188000, 30842004, 410450009, 53524009, 21593001, 20067007) based on SME/expert recommendations.	Terminology	Annual Update
Value Set 'Telephone Visits' (2.16.840.1.113883.3.464.1003.101.12.1080): Added 8 CPT codes (98009, 98013, 98010, 98011, 98014, 98008, 98015, 98012) based on review by technical experts, SMEs and/or public feedback.	Terminology	Annual Update

Compare Versions of: "Diabetes: Eye Exam"

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