CQM Measure CMS131v5 Diabetes: Eye Exam

CQM Measure CMS131v5 Diabetes: Eye Exam

NQS Domain: Clinical Process/Effectiveness 

Description: Percentage of patients 18-75 years of age with diabetes who had a retinal or dilated eye exam by an eye care professional during the measurement period or a negative retinal exam (no evidence of retinopathy) in the 12 months prior to 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

Patient had one or more appointment during measurement period, with CPT code in [2022F, 2024F, 2026F, 3072F, 67028, 67030, 67031, 67036, 67038, 67039, 67040, 67041, 67042, 67043, 67101, 67105, 67107, 67108, 67110, 67112, 67113, 67121, 67141, 67145, 67208, 67210, 67218, 67220, 67221, 67227, 67228, 92002, 92004, 92012, 92014, 92018, 92019, 92225, 92226, 92230, 92235, 92240, 92250, 92260] or HCPCS code in [S0620, S0621, S0625, S3000] entered.

Exclusion Logic

Patient had active patient problem Gestational Diabetes recorded during measurement period.

For more information, please visit the CMS website at 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 or HCPCS codes (indicated in the denominator section) entered.

Step 3: Ensure that the patient had one or more appointment scheduled during the measurement period with one of the above CPT or HCPCS codes (indicated in the numerator section) entered.

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