CQM Measure CMS122v5 Diabetes: Hemoglobin A1c (HbA1c) Poor Control (> 9%)

CQM Measure CMS122v5 Diabetes: Hemoglobin A1c (HbA1c) Poor Control (> 9%)

NQS Domain: Clinical Process/Effectiveness

Description: Percentage of patients 18-75 years of age with diabetes who had hemoglobin A1c > 9.0% during the measurement period.

Denominator Logic

Patient was >= 18 years old on or before the start of measurement period.


AND Patient was < 75 years old on or before the start of measurement period.


AND Patient had active patient problem Diabetes (CQM ValueSet: 2.16.840.1.113883.3.464.1003.103.12.1001) recorded during measurement period.

AND Patient had one or more appointment scheduled during measurement period, with CPT code in [99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99385, 99386, 99387, 99395, 99396, 99397] or HCPCS code in [G0438, G0439] entered.

Numerator Logic

OR Patient had no lab test HbA1c Laboratory Test (CQM ValueSet: 2.16.840.1.113883.3.464.1003.198.12.1013) recorded during measurement period.

OR Patient's most recent lab test HbA1c Laboratory Test(CQM ValueSet: 2.16.840.1.113883.3.464.1003.198.12.1013) during measurement period had not result.

OR Patient's most recent lab test HbA1c Laboratory Test (CQM ValueSet: 2.16.840.1.113883.3.464.1003.198.12.1013) during measurement period had result > 9% entered.

For more information, please visit the CMS website here.

How To (Website)

Step 1: Ensure that “Diabetes” is cataloged for the patient in the “Problem List” area of the patient record. 

Step 2: Ensure that the patient had one or more appointment scheduled during the measurement period with one of the above CPT codes (indicated in the denominator fields) entered.

Step 3: Create Lab Order for the patient with Lab Description “Hemoglobin A1c/Hemoglobin”

Step 4: Once the lab results are received, enter the lab results in the “Lab result value field” pictured below. Ensure that Lab order status is set to “Results Received” (when results are received)

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