Metadata
Title Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes CareFHIR
Version 1.0.000
Short Name CMS142FHIR
GUID (Version Independent) urn:uuid:0f55e61f-dc17-4fe4-a604-7f030260618f
GUID (Version Specific) urn:uuid:37dd2397-d9cd-401d-b343-28d77fd2f923
CMS Identifier 142FHIR
Effective Period 2026-01-01 through 2026-12-31
Steward (Publisher) American Academy of Ophthalmology
Developer American Academy of Ophthalmology
Developer American Medical Association (AMA)
Description

Percentage of patients aged 18 years and older with a diagnosis of diabetic retinopathy who had a dilated macular or fundus exam performed with documented communication to the physician who manages the ongoing care of the patient with diabetes mellitus regarding the findings of the macular or fundus exam at least once during the measurement period
Copyright

Copyright 2025 American Academy of Ophthalmology. All Rights Reserved.
Disclaimer

The Measure is not a clinical guideline, does not establish a standard of medical care, and has not been tested for all potential applications. The Measure, while copyrighted, can be reproduced and distributed, without modification, for noncommercial purposes, e.g., use by health care providers in connection with their practices. Commercial use is defined as the sale, license, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain. Commercial uses of the Measure require a license agreement between the user and the American Academy of Ophthalmology (Academy). Neither the Academy, its members, the American Medical Association (AMA), nor the former AMA-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI), nor PCPI, nor their members shall be responsible for any use of the Measure. The PCPI's and AMA's significant past efforts and contributions to the development and updating of the Measures are acknowledged. The National Committee for Quality Assurance's significant past efforts and contributions to the development and updating of the Measure is acknowledged. THE MEASURE AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND. Limited proprietary coding is contained in the Measure specifications for convenience. A license agreement must be entered prior to a third party's use of Current Procedural Terminology (CPT[R]) or other proprietary code set contained in the Measures. Any other use of CPT or other coding by the third party is strictly prohibited. The Academy, the AMA, and former members of the PCPI disclaim all liability for use or accuracy of any CPT or other coding contained in the specifications. CPT(R) contained in the Measure specifications is copyright 2004-2024 American Medical Association. LOINC(R) is copyright 2004-2024 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2024 International Health Terminology Standards Development Organisation. ICD-10 is copyright 2024 World Health Organization. All Rights Reserved. Due to technical limitations, registered trademarks are indicated by (R) or [R].
Rationale

Diabetic retinopathy is a prevalent complication of diabetes, estimated to affect 28.5% of diabetic patients in the US (Zhang et al., 2010). Diabetic retinopathy is a key indicator of systemic complications of diabetes (Zhang et al., 2010). Coordination of care between the eye care specialist and the physician managing a patient's ongoing diabetes care is essential in stemming the progression of vision loss. Communication from the eye care specialist to a primary care physician facilitates the exchange of information about the severity and progression of a patient's diabetic retinopathy, adherence to recommended ocular care, need for follow-up visits, and treatment plans (Storey et al., 2016). Data from the Diabetes Control and Complications Trial showed that diabetic treatment and maintenance of glucose control delays the onset and slows the progression of diabetic retinopathy (Aiello & DCCT/EDIC Research Group, 2014).
Clinical Recommendation Statement

The ophthalmologist should refer patients with diabetes to a primary care physician or endocrinologist for appropriate management of their systemic condition and should communicate examination results to the physician managing the patient's ongoing diabetes care (Lim et al., 2025). A goal is to achieve optimal control of blood glucose, blood pressure, and other risk factors through close communication with the patient's primary care physician on the status of the DR and the need for optimal metabolic control (Lim et al,, 2025). Establishing a close partnership between the ophthalmologist and the primary care physician is an important step to ensure optimal patient care. Furthermore, it is important to help educate patients with diabetes as well as their primary care physician about the ophthalmologic implications of controlling blood glucose (as monitored by HbA1c) to as near to normal as is safely possible (Lim et al., 2025).
Citation

Aiello, L. P., & DCCT/EDIC Research Group (2014). Diabetic retinopathy and other ocular findings in the diabetes control and complications trial/epidemiology of diabetes interventions and complications study. Diabetes care, 37(1), 17--23. doi:10.2337/dc13-2251
Citation

Lim, J.I., Kim, S.J., Bailey, S.T., Kovach, J.L., Vemulakonda, G.A., Ying, G., Flaxel, C.J. and the American Academy of Ophthalmology Preferred Practice Pattern Retina/Vitreous Committee (2025). Diabetic Retinopathy Preferred Practice Pattern. Ophthalmology. 2025 in press. doi: 10.1016/j.ophtha.2024.12.020
Citation

Storey, P. P., Murchison, A. P., Pizzi, L. T., Hark, L. A., Dai, Y., Leiby, B. E., & Haller, J. A. Impact of physician communication on diabetic eye examination adherence: Results from a Retrospective Cohort Analysis. Retina. 2016 Jan;36(1),20-7. doi:10.1097/IAE.0000000000000652
Citation

Zhang, X., Saaddine, J. B., Chou, C. F., Cotch, M. F., Cheng, Y. J., Geiss, L. S., ... Klein, R. (2010). Prevalence of diabetic retinopathy in the United States, 2005-2008. JAMA, 304(6), 649--656. doi:10.1001/jama.2010.1111
Definition Communication: May include documentation in the medical record indicating that the findings of the dilated macular or fundus exam were communicated (e.g., verbally, by letter) with the clinician managing the patient's diabetic care OR a copy of a letter in the medical record to the clinician managing the patient's diabetic care outlining the findings of the dilated macular or fundus exam
Definition Findings: Includes level of severity of retinopathy (e.g., mild nonproliferative, moderate nonproliferative, severe nonproliferative, very severe nonproliferative, proliferative) AND the presence or absence of macular edema
Guidance (Usage) The measure, as written, does not specifically require documentation of laterality. Coding limitations in particular clinical terminologies do not currently allow for that level of specificity (ICD-10-CM includes laterality, but SNOMED-CT does not uniformly include this distinction). Therefore, at this time, it is not a requirement of this measure to indicate laterality of the diagnoses, findings or procedures. Available coding to capture the data elements specified in this measure has been provided. It is assumed that the eligible clinician will record laterality in the patient medical record, as quality care and clinical documentation should include laterality. The communication of results, including the level of severity of diabetic retinopathy and presence or absence of macular edema to the primary care physician providing ongoing care of a patient's diabetes should be completed soon after the dilated exam is performed. Eligible clinicians reporting on this measure should note that all data for the measurement period is to be submitted by the deadline established by CMS. Therefore, eligible clinicians who see patients towards the end of the measurement period (i.e., December in particular), should communicate the results of the dilated macular exam as soon as possible in order for those patients to be counted in the measure numerator. Communicating the results as soon as possible after the date of the exam will ensure the data are included in the submission to CMS. This eCQM is a patient-based measure. Telehealth encounters are not eligible for this measure because the measure requires a clinical action that cannot be conducted via telehealth. This FHIR-based measure has been derived from the QDM-based measure CMS142v14. Please refer to the HL7 QI-Core Implementation Guide (https://hl7.org/fhir/us/qicore/STU6/) for more information on QI-Core and mapping recommendations from QDM to QI-Core STU 6 (https://hl7.org/fhir/us/qicore/STU6/qdm-to-qicore.html).
Measure Group (Rate) (ID: Group_1)
Basis boolean
Scoring Proportion
Improvement Notation Increased score indicates improvement
Type Process
Initial Population ID: InitialPopulation_1
Description:

All patients aged 18 years and older with a diagnosis of diabetic retinopathy during the measurement period

Criteria: Initial Population
Denominator ID: Denominator_1
Description:

Equals Initial Population who had a dilated macular or fundus exam performed during the measurement period

Criteria: Denominator
Denominator Exception ID: DenominatorException_1
Description:

* Documentation of medical reason(s) for not communicating the findings of the dilated macular or fundus exam to the physician who manages the ongoing care of the patient with diabetes. * Documentation of patient reason(s) for not communicating the findings of the dilated macular or fundus exam to the physician who manages the ongoing care of the patient with diabetes.

Criteria: Denominator Exceptions
Numerator ID: Numerator_1
Description:

Patients with documentation, at least once within the measurement period, of the findings of the dilated macular or fundus exam via communication to the physician who manages the patient's diabetic care

Criteria: Numerator
For every patient evaluated by this measure also identify payer, race, ethnicity and sex
Supplemental Data Elements
Supplemental Data Element ID: sde-ethnicity
Usage Code: Supplemental Data
Description: SDE Ethnicity
Logic Definition: SDE Ethnicity
Supplemental Data Element ID: sde-payer
Usage Code: Supplemental Data
Description: SDE Payer
Logic Definition: SDE Payer
Supplemental Data Element ID: sde-race
Usage Code: Supplemental Data
Description: SDE Race
Logic Definition: SDE Race
Supplemental Data Element ID: sde-sex
Usage Code: Supplemental Data
Description: SDE Sex
Logic Definition: SDE Sex
Measure Logic
Primary Library https://madie.cms.gov/Library/CMS142FHIRCommWithDrManagingDiab
Contents Population Criteria
Logic Definitions
Terminology
Dependencies
Data Requirements
Parameters
Population Criteria
Measure Group (Rate) (ID: Group_1)
Initial Population 
define "Initial Population":
  AgeInYearsAt(date from start of "Measurement Period") >= 18
    and exists "Diabetic Retinopathy Encounter"
Definition
Denominator 
define "Denominator":
  "Initial Population"
    and exists "Macular Exam Performed"
Definition
Denominator Exception 
define "Denominator Exceptions":
  exists "Medical or Patient Reason for Not Communicating Level of Severity of Retinopathy"
    or exists "Medical or Patient Reason for Not Communicating Absence of Macular Edema"
    or exists "Medical or Patient Reason for Not Communicating Presence of Macular Edema"
Definition
Numerator 
define "Numerator":
  exists "Level of Severity of Retinopathy Findings Communicated"
    and ( exists "Macular Edema Absence Communicated"
        or exists "Macular Edema Presence Communicated"
    )
Definition
Logic Definitions
Logic Definition Library Name: SupplementalDataElements 
define "SDE Sex":
  case
    when Patient.sex() = '248153007' then "Male (finding)"
    when Patient.sex() = '248152002' then "Female (finding)"
    else null
  end
Logic Definition Library Name: SupplementalDataElements 
define "SDE Payer":
  [USQualityCore.Coverage: type in "Payer Type"] Payer
    return {
      code: Payer.type,
      period: Payer.period
    }
Logic Definition Library Name: SupplementalDataElements 
define "SDE Ethnicity":
  (Patient.ethnicity()) E
    return Tuple {
      codes: { E.ombCategory } union E.detailed,
      display: E.text
    }
Logic Definition Library Name: SupplementalDataElements 
define "SDE Race":
  (Patient.race()) R
    return Tuple {
      codes: R.ombCategory union R.detailed,
      display: R.text
    }
Logic Definition Library Name: CMS142FHIRCommWithDrManagingDiab 
define "SDE Sex":
  SDE."SDE Sex"
Logic Definition Library Name: CMS142FHIRCommWithDrManagingDiab 
define "Qualifying Encounter During Day of Measurement Period":
  ( ["Encounter": "Office Visit"]
    union ["Encounter": "Ophthalmological Services"]
    union ["Encounter": "Outpatient Consultation"]
    union ["Encounter": "Care Services in Long-Term Residential Facility"]
    union ["Encounter": "Nursing Facility Visit"] ) QualifyingEncounter
    where QualifyingEncounter.period during day of "Measurement Period"
      and QualifyingEncounter.status = 'finished'
      and QualifyingEncounter.class !~ "virtual"
Logic Definition Library Name: CMS142FHIRCommWithDrManagingDiab 
define "Diabetic Retinopathy Encounter":
  "Qualifying Encounter During Day of Measurement Period" ValidQualifyingEncounter
    with ( ["ConditionProblemsHealthConcerns": "Diabetic Retinopathy"]
      union ["ConditionEncounterDiagnosis": "Diabetic Retinopathy"] ) DiabeticRetinopathy
      such that DiabeticRetinopathy.onset.toInterval ( ) overlaps day of ValidQualifyingEncounter.period
        and DiabeticRetinopathy.isVerified ( )
Logic Definition Library Name: CMS142FHIRCommWithDrManagingDiab 
define "Level of Severity of Retinopathy Findings Communicated":
  ["Communication": category in "Level of Severity of Retinopathy Findings"] LevelOfSeverityCommunicated
    with "Diabetic Retinopathy Encounter" EncounterDiabeticRetinopathy
      such that LevelOfSeverityCommunicated.sent after start of EncounterDiabeticRetinopathy.period
        and LevelOfSeverityCommunicated.sent during day of "Measurement Period"
    where LevelOfSeverityCommunicated.status = 'completed'
Logic Definition Library Name: CMS142FHIRCommWithDrManagingDiab 
define "Macular Edema Absence Communicated":
  ["Communication": category in "Macular Edema Findings Absent"] MacularEdemaAbsentCommunicated
    with "Diabetic Retinopathy Encounter" EncounterDiabeticRetinopathy
      such that MacularEdemaAbsentCommunicated.sent after start of EncounterDiabeticRetinopathy.period
        and MacularEdemaAbsentCommunicated.sent during day of "Measurement Period"
    where MacularEdemaAbsentCommunicated.status = 'completed'
Logic Definition Library Name: CMS142FHIRCommWithDrManagingDiab 
define "Macular Edema Presence Communicated":
  ["Communication": category in "Macular Edema Findings Present"] MacularEdemaPresentCommunicated
    with "Diabetic Retinopathy Encounter" EncounterDiabeticRetinopathy
      such that MacularEdemaPresentCommunicated.sent after start of EncounterDiabeticRetinopathy.period
        and MacularEdemaPresentCommunicated.sent during "Measurement Period"
    where MacularEdemaPresentCommunicated.status = 'completed'
Logic Definition Library Name: CMS142FHIRCommWithDrManagingDiab 
define "Numerator":
  exists "Level of Severity of Retinopathy Findings Communicated"
    and ( exists "Macular Edema Absence Communicated"
        or exists "Macular Edema Presence Communicated"
    )
Logic Definition Library Name: CMS142FHIRCommWithDrManagingDiab 
define "Initial Population":
  AgeInYearsAt(date from start of "Measurement Period") >= 18
    and exists "Diabetic Retinopathy Encounter"
Logic Definition Library Name: CMS142FHIRCommWithDrManagingDiab 
define "Macular Exam Performed":
  ["ObservationClinicalResult": "Macular Exam"] MacularExam
    with "Diabetic Retinopathy Encounter" EncounterDiabeticRetinopathy
      such that MacularExam.effective.toInterval ( ) during EncounterDiabeticRetinopathy.period
    where MacularExam.value is not null
      and MacularExam.status in { 'final', 'amended', 'corrected' }
Logic Definition Library Name: CMS142FHIRCommWithDrManagingDiab 
define "Denominator":
  "Initial Population"
    and exists "Macular Exam Performed"
Logic Definition Library Name: CMS142FHIRCommWithDrManagingDiab 
define "SDE Payer":
  SDE."SDE Payer"
Logic Definition Library Name: CMS142FHIRCommWithDrManagingDiab 
define "SDE Ethnicity":
  SDE."SDE Ethnicity"
Logic Definition Library Name: CMS142FHIRCommWithDrManagingDiab 
define "SDE Race":
  SDE."SDE Race"
Logic Definition Library Name: CMS142FHIRCommWithDrManagingDiab 
define "Medical or Patient Reason for Not Communicating Level of Severity of Retinopathy":
  [CommunicationNotDone: category in "Level of Severity of Retinopathy Findings"] LevelOfSeverityNotCommunicated
    with "Diabetic Retinopathy Encounter" EncounterDiabeticRetinopathy
      such that LevelOfSeverityNotCommunicated.recorded () during day of EncounterDiabeticRetinopathy.period
    where ( LevelOfSeverityNotCommunicated.statusReason in "Medical Reason"
        or LevelOfSeverityNotCommunicated.statusReason in "Patient Reason"
    )
Logic Definition Library Name: CMS142FHIRCommWithDrManagingDiab 
/* Note: 
below definition workaround for 
https://oncprojectracking.healthit.gov/support/browse/CQLIT-371. Using value set workaround has been applied for now
but when QI Core STU 5 gets in the tool, it may be reverted back to a DRC */


define "Medical or Patient Reason for Not Communicating Absence of Macular Edema":
  [CommunicationNotDone: category in "Macular Edema Findings Absent"] MacularEdemaAbsentNotCommunicated
    with "Diabetic Retinopathy Encounter" EncounterDiabeticRetinopathy
      such that MacularEdemaAbsentNotCommunicated.sent during day of EncounterDiabeticRetinopathy.period
    where ( MacularEdemaAbsentNotCommunicated.statusReason in "Medical Reason"
        or MacularEdemaAbsentNotCommunicated.statusReason in "Patient Reason"
    )
Logic Definition Library Name: CMS142FHIRCommWithDrManagingDiab 
define "Medical or Patient Reason for Not Communicating Presence of Macular Edema":
  [CommunicationNotDone: category in "Macular Edema Findings Present"] MacularEdemaPresentNotCommunicated
    with "Diabetic Retinopathy Encounter" EncounterDiabeticRetinopathy
      such that MacularEdemaPresentNotCommunicated.sent during day of EncounterDiabeticRetinopathy.period
    where ( MacularEdemaPresentNotCommunicated.statusReason in "Medical Reason"
        or MacularEdemaPresentNotCommunicated.statusReason in "Patient Reason"
    )
Logic Definition Library Name: CMS142FHIRCommWithDrManagingDiab 
define "Denominator Exceptions":
  exists "Medical or Patient Reason for Not Communicating Level of Severity of Retinopathy"
    or exists "Medical or Patient Reason for Not Communicating Absence of Macular Edema"
    or exists "Medical or Patient Reason for Not Communicating Presence of Macular Edema"
Logic Definition Library Name: CMS142FHIRCommWithDrManagingDiab 
define fluent function isVerified(condition Choice<ConditionEncounterDiagnosis, ConditionProblemsHealthConcerns>):
  condition.verificationStatus is not null implies ( condition.verificationStatus ~ Status."confirmed"
      or condition.verificationStatus ~ Status."unconfirmed"
      or condition.verificationStatus ~ Status."provisional"
      or condition.verificationStatus ~ Status."differential"
  )
Logic Definition Library Name: FHIRHelpers 
define function ToString(value string): value.value
Logic Definition Library Name: FHIRHelpers 
define function ToString(value uri): value.value
Logic Definition Library Name: FHIRHelpers 
/*
@description: Converts the given [Period](https://hl7.org/fhir/datatypes.html#Period)
value to a CQL DateTime Interval
@comment: If the start value of the given period is unspecified, the starting
boundary of the resulting interval will be open (meaning the start of the interval
is unknown, as opposed to interpreted as the beginning of time).
*/
define function ToInterval(period FHIR.Period):
    if period is null then
        null
    else
        if period."start" is null then
            Interval(period."start".value, period."end".value]
        else
            Interval[period."start".value, period."end".value]
Logic Definition Library Name: FHIRHelpers 
define function ToString(value EncounterStatus): value.value
Logic Definition Library Name: FHIRHelpers 
/*
@description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code.
*/
define function ToCode(coding FHIR.Coding):
    if coding is null then
        null
    else
        System.Code {
          code: coding.code.value,
          system: coding.system.value,
          version: coding.version.value,
          display: coding.display.value
        }
Logic Definition Library Name: FHIRHelpers 
define function ToDateTime(value dateTime): value.value
Logic Definition Library Name: FHIRHelpers 
define function ToDateTime(value instant): value.value
Logic Definition Library Name: FHIRHelpers 
define function ToDate(value date): value.value
Logic Definition Library Name: FHIRHelpers 
/*
@description: Converts the given FHIR [Quantity](https://hl7.org/fhir/datatypes.html#Quantity) 
value to a CQL Quantity
@comment: If the given quantity has a comparator specified, a runtime error is raised. If the given quantity
has a system other than UCUM (i.e. `http://unitsofmeasure.org`) or CQL calendar units (i.e. `http://hl7.org/fhirpath/CodeSystem/calendar-units`)
an error is raised. For UCUM to calendar units, the `ToCalendarUnit` function is used.
@seealso: ToCalendarUnit
*/
define function ToQuantity(quantity FHIR.Quantity):
    case
        when quantity is null then null
        when quantity.value is null then null
        when quantity.comparator is not null then
            Message(null, true, 'FHIRHelpers.ToQuantity.ComparatorQuantityNotSupported', 'Error', 'FHIR Quantity value has a comparator and cannot be converted to a System.Quantity value.')
        when quantity.system is null or quantity.system.value = 'http://unitsofmeasure.org'
              or quantity.system.value = 'http://hl7.org/fhirpath/CodeSystem/calendar-units' then
            System.Quantity { value: quantity.value.value, unit: ToCalendarUnit(Coalesce(quantity.code.value, quantity.unit.value, '1')) }
        else
            Message(null, true, 'FHIRHelpers.ToQuantity.InvalidFHIRQuantity', 'Error', 'Invalid FHIR Quantity code: ' & quantity.unit.value & ' (' & quantity.system.value & '|' & quantity.code.value & ')')
    end
Logic Definition Library Name: FHIRHelpers 
/*
@description: Converts a UCUM definite duration unit to a CQL calendar duration
unit using conversions specified in the [quantities](https://cql.hl7.org/02-authorsguide.html#quantities) 
topic of the CQL specification.
@comment: Note that for durations above days (or weeks), the conversion is understood to be approximate
*/
define function ToCalendarUnit(unit System.String):
    case unit
        when 'ms' then 'millisecond'
        when 's' then 'second'
        when 'min' then 'minute'
        when 'h' then 'hour'
        when 'd' then 'day'
        when 'wk' then 'week'
        when 'mo' then 'month'
        when 'a' then 'year'
        else unit
    end
Logic Definition Library Name: FHIRHelpers 
/*
@description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept.
*/
define function ToConcept(concept FHIR.CodeableConcept):
    if concept is null then
        null
    else
        System.Concept {
            codes: concept.coding C return ToCode(C),
            display: concept.text.value
        }
Logic Definition Library Name: FHIRHelpers 
define function ToString(value CommunicationStatus): value.value
Logic Definition Library Name: FHIRHelpers 
define function ToString(value ObservationStatus): value.value
Logic Definition Library Name: FHIRCommon 
/*
@description: Returns the single extension (if present) on the given resource with the specified url.
@comment: This function uses singleton from to ensure that a run-time exception is thrown if there
is more than one extension on the given resource with the specified url.
*/
define fluent function ext(domainResource DomainResource, url String):
  singleton from domainResource.exts(url)
Logic Definition Library Name: FHIRCommon 
/*
@description: Returns any extensions defined on the given resource with the specified url
*/
define fluent function exts(domainResource DomainResource, url String):
  domainResource.extension E
    where E.url = url
    return E
Logic Definition Library Name: FHIRCommon 
/*
@description: Normalizes a value that is a choice of timing-valued types to an equivalent interval
@comment: Normalizes a choice type of FHIR.dateTime, FHIR.Period, FHIR.Timing, FHIR.instance, FHIR.string, FHIR.Age, or FHIR.Range types
to an equivalent interval. This selection of choice types is a superset of the majority of choice types that are used as possible
representations for timing-valued elements in FHIR, allowing this function to be used across any resource.

The input can be provided as a dateTime, Period, Timing, instant, string, Age, or Range.
The intent of this function is to provide a clear and concise mechanism to treat single
elements that have multiple possible representations as intervals so that logic doesn't have to account
for the variability. More complex calculations (such as medication request period or dispense period
calculation) need specific guidance and consideration. That guidance may make use of this function, but
the focus of this function is on single element calculations where the semantics are unambiguous.
If the input is a dateTime, the result a DateTime Interval beginning and ending on that dateTime.
If the input is a Period, the result is a DateTime Interval.
If the input is a Timing, an error is raised indicating a single interval cannot be computed from a Timing.
If the input is an instant, the result is a DateTime Interval beginning and ending on that instant.
If the input is a string, an error is raised indicating a single interval cannot be computed from a string.
If the input is an Age, the result is a DateTime Interval beginning when the patient was the given Age,
and ending immediately prior to when the patient was the given Age plus one year.
If the input is a Range, the result is a DateTime Interval beginning when the patient was the Age given
by the low end of the Range, and ending immediately prior to when the patient was the Age given by the
high end of the Range plus one year.

NOTE: Due to the
complexity of determining a single interval from a Timing or String type, this function will throw a run-time exception if it is used
with a Timing or String.
*/
define fluent function toInterval(choice Choice<FHIR.dateTime, FHIR.Period, FHIR.Timing, FHIR.instant, FHIR.string, FHIR.Age, FHIR.Range>):
  case
    when choice is FHIR.dateTime then
      Interval[FHIRHelpers.ToDateTime(choice as FHIR.dateTime), FHIRHelpers.ToDateTime(choice as FHIR.dateTime)]
    when choice is FHIR.Period then
      FHIRHelpers.ToInterval(choice as FHIR.Period)
    when choice is FHIR.instant then
      Interval[FHIRHelpers.ToDateTime(choice as FHIR.instant), FHIRHelpers.ToDateTime(choice as FHIR.instant)]
    when choice is FHIR.Age then
      Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(choice as FHIR.Age),
        FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(choice as FHIR.Age) + 1 year)
    when choice is FHIR.Range then
      Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((choice as FHIR.Range).low),
        FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((choice as FHIR.Range).high) + 1 year)
    when choice is FHIR.Timing then
      Message(null as Interval<DateTime>, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a Timing value is not supported')
    when choice is FHIR.string then
      Message(null as Interval<DateTime>, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a String value is not supported')
    else
      null as Interval<DateTime>
  end
Logic Definition Library Name: FHIRCommon 
/*
@description: Returns the single extension (if present) on the given element with the specified url.
@comment: This function uses singleton from to ensure that a run-time exception is thrown if there
is more than one extension on the given element with the specified url.
*/
define fluent function ext(element Element, url String):
  singleton from element.exts(url)
Logic Definition Library Name: FHIRCommon 
/*
@description: Returns any extensions defined on the given element with the specified url.
*/
define fluent function exts(element Element, url String):
  element.extension E
    where E.url = url
    return E
Logic Definition Library Name: USCoreCommon 
/*
@description: Returns the sex element as defined for the USCore patient profile
*/
define fluent function sex(patient Patient):
  patient.ext('http://hl7.org/fhir/us/core/StructureDefinition/us-core-sex').value as FHIR.code
Logic Definition Library Name: USCoreCommon 
define fluent function ethnicity(patient Patient):
  (patient.ext('http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity')) E
    return {
      ombCategory: E.ext('ombCategory').value as FHIR.Coding,
      detailed: (E.exts('detailed')) d return d.value as FHIR.Coding,
      text: E.ext('text').value as FHIR.string
    }
Logic Definition Library Name: USCoreCommon 
define fluent function race(patient Patient):
  (patient.ext('http://hl7.org/fhir/us/core/StructureDefinition/us-core-race')) E
    return {
      ombCategory: (E.exts('ombCategory')) o return o.value as FHIR.Coding,
      detailed: (E.exts('detailed')) d return d.value as FHIR.Coding,
      text: E.ext('text').value as FHIR.string
    }
Logic Definition Library Name: USQualityCoreCommon 
/*
@description: Returns the value of the recorded extension for a Communication Not Done
*/
define fluent function recorded(communicationNotDone CommunicationNotDone):
  communicationNotDone.ext('http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-recorded').value as FHIR.dateTime
Terminology
Code System Description: Code system SNOMEDCT
Resource: SNOMED CT (all versions)
Canonical URL: http://snomed.info/sct
Code System Description: Code system ActCode
Resource: ActCode
Canonical URL: http://terminology.hl7.org/CodeSystem/v3-ActCode
Code System Description: Code system ConditionVerificationStatusCodes
Resource: ConditionVerificationStatus
Canonical URL: http://terminology.hl7.org/CodeSystem/condition-ver-status
Value Set Description: Value set Level of Severity of Retinopathy Findings
Resource: Level of Severity of Retinopathy Findings
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1283
Value Set Description: Value set Office Visit
Resource: Office Visit
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001
Value Set Description: Value set Ophthalmological Services
Resource: Ophthalmological Services
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1285
Value Set Description: Value set Outpatient Consultation
Resource: Outpatient Consultation
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1008
Value Set Description: Value set Care Services in Long-Term Residential Facility
Resource: Care Services in Long Term Residential Facility
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1014
Value Set Description: Value set Nursing Facility Visit
Resource: Nursing Facility Visit
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1012
Value Set Description: Value set Diabetic Retinopathy
Resource: Diabetic Retinopathy
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.327
Value Set Description: Value set Macular Edema Findings Absent
Resource: Macular Edema Findings Absent
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.2.1391
Value Set Description: Value set Macular Edema Findings Present
Resource: Macular Edema Findings Present
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1320
Value Set Description: Value set Macular Exam
Resource: Macular Exam
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1251
Value Set Description: Value set Payer Type
Resource: Payer Type
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591
Value Set Description: Value set Medical Reason
Resource: Medical Reason
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1007
Value Set Description: Value set Patient Reason
Resource: Patient Reason
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1008
Direct Reference Code Display: Male (finding)
Code: 248153007
System: http://snomed.info/sct
Direct Reference Code Display: Female (finding)
Code: 248152002
System: http://snomed.info/sct
Direct Reference Code Display: virtual
Code: VR
System: http://terminology.hl7.org/CodeSystem/v3-ActCode
Direct Reference Code Display: confirmed
Code: confirmed
System: http://terminology.hl7.org/CodeSystem/condition-ver-status
Direct Reference Code Display: unconfirmed
Code: unconfirmed
System: http://terminology.hl7.org/CodeSystem/condition-ver-status
Direct Reference Code Display: provisional
Code: provisional
System: http://terminology.hl7.org/CodeSystem/condition-ver-status
Direct Reference Code Display: differential
Code: differential
System: http://terminology.hl7.org/CodeSystem/condition-ver-status
Dependencies
Dependency Description: USQualityCore model information
Resource: https://madie.cms.gov/Library/USQualityCore-ModelInfo|0.1.0-cibuild
Canonical URL: https://madie.cms.gov/Library/USQualityCore-ModelInfo|0.1.0-cibuild
Dependency Description: USCore model information
Resource: http://hl7.org/fhir/us/cql/Library/USCore-ModelInfo|6.1.0-derived
Canonical URL: http://hl7.org/fhir/us/cql/Library/USCore-ModelInfo|6.1.0-derived
Dependency Description: FHIR model information
Resource: http://hl7.org/fhir/uv/cql/Library/FHIR-ModelInfo|4.0.1
Canonical URL: http://hl7.org/fhir/uv/cql/Library/FHIR-ModelInfo|4.0.1
Dependency Description: Library SDE
Resource: SupplementalDataElements version: 6.1.000
Canonical URL: https://madie.cms.gov/Library/SupplementalDataElements|6.1.000
Dependency Description: Library FHIRHelpers
Resource: http://hl7.org/fhir/uv/cql/Library/FHIRHelpers|4.0.1
Canonical URL: http://hl7.org/fhir/uv/cql/Library/FHIRHelpers|4.0.1
Dependency Description: Library USCommon
Resource: http://hl7.org/fhir/us/cql/Library/USCoreCommon|2.0.0-ballot
Canonical URL: http://hl7.org/fhir/us/cql/Library/USCoreCommon|2.0.0-ballot
Dependency Description: Library FHIRCommon
Resource: http://hl7.org/fhir/uv/cql/Library/FHIRCommon|2.0.0
Canonical URL: http://hl7.org/fhir/uv/cql/Library/FHIRCommon|2.0.0
Dependency Description: Library Status
Resource: Status version: 2.1.000
Canonical URL: https://madie.cms.gov/Library/Status|2.1.000
Dependency Description: Library USQualityCoreCommon
Resource: US Quality Core Common version: 0.1.0-cibuild
Canonical URL: https://madie.cms.gov/Library/USQualityCoreCommon|0.1.0-cibuild
Data Requirements
Data Requirement Type: Patient
Profile(s): http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-patient
Must Support Elements: ombCategory, detailed, text
Data Requirement Type: Encounter
Profile(s): Encounter
Must Support Elements: type, period, status, class
Code Filter(s):
Path: type
ValueSet: Office Visit
Data Requirement Type: Encounter
Profile(s): Encounter
Must Support Elements: type, period, status, class
Code Filter(s):
Path: type
ValueSet: Ophthalmological Services
Data Requirement Type: Encounter
Profile(s): Encounter
Must Support Elements: type, period, status, class
Code Filter(s):
Path: type
ValueSet: Outpatient Consultation
Data Requirement Type: Encounter
Profile(s): Encounter
Must Support Elements: type, period, status, class
Code Filter(s):
Path: type
ValueSet: Care Services in Long Term Residential Facility
Data Requirement Type: Encounter
Profile(s): Encounter
Must Support Elements: type, period, status, class
Code Filter(s):
Path: type
ValueSet: Nursing Facility Visit
Data Requirement Type: Patient
Profile(s): Patient
Must Support Elements: birthDate
Data Requirement Type: Condition
Profile(s): http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-condition-problems-health-concerns
Must Support Elements: code
Code Filter(s):
Path: code
ValueSet: Diabetic Retinopathy
Data Requirement Type: Condition
Profile(s): http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-condition-encounter-diagnosis
Must Support Elements: code
Code Filter(s):
Path: code
ValueSet: Diabetic Retinopathy
Data Requirement Type: Communication
Profile(s): Communication
Must Support Elements: category, sent, status
Code Filter(s):
Path: category
ValueSet: Level of Severity of Retinopathy Findings
Path: status
Code(s): [not stated]: completed (completed)
Data Requirement Type: Communication
Profile(s): Communication
Must Support Elements: category, sent, status
Code Filter(s):
Path: category
ValueSet: Macular Edema Findings Absent
Path: status
Code(s): [not stated]: completed (completed)
Data Requirement Type: Communication
Profile(s): Communication
Must Support Elements: category, sent, status
Code Filter(s):
Path: category
ValueSet: Macular Edema Findings Present
Path: status
Code(s): [not stated]: completed (completed)
Data Requirement Type: Observation
Profile(s): http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-observation-clinical-result
Must Support Elements: code, effective, value, status
Code Filter(s):
Path: code
ValueSet: Macular Exam
Data Requirement Type: Coverage
Profile(s): http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-coverage
Must Support Elements: type, period
Code Filter(s):
Path: type
ValueSet: Payer Type
Data Requirement Type: Communication
Profile(s): http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-communicationnotdone
Must Support Elements: category, statusReason
Code Filter(s):
Path: category
ValueSet: Level of Severity of Retinopathy Findings
Data Requirement Type: Communication
Profile(s): http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-communicationnotdone
Must Support Elements: category, sent, statusReason
Code Filter(s):
Path: category
ValueSet: Macular Edema Findings Absent
Data Requirement Type: Communication
Profile(s): http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-communicationnotdone
Must Support Elements: category, sent, statusReason
Code Filter(s):
Path: category
ValueSet: Macular Edema Findings Present
Parameters
Name Use Card. Type Documentation
Measurement Period In 0..1 Period
SDE Sex Out 0..1 Coding
Numerator Out 0..1 boolean
Denominator Out 0..1 boolean
SDE Payer Out 0..* Resource
Initial Population Out 0..1 boolean
SDE Ethnicity Out 0..1 Resource
SDE Race Out 0..1 Resource
Denominator Exceptions Out 0..1 boolean
Generated using version 0.5.4 of the sample-content-ig Liquid templates
<status value="active"/> <experimental value="false"/> <date value="2026-01-16T18:18:13+00:00"/> <publisher value="American Academy of Ophthalmology"/> <contact> <telecom> <system value="url"/> <value value="www.aao.org"/> </telecom> </contact> <description value="Percentage of patients aged 18 years and older with a diagnosis of diabetic retinopathy who had a dilated macular or fundus exam performed with documented communication to the physician who manages the ongoing care of the patient with diabetes mellitus regarding the findings of the macular or fundus exam at least once during the measurement period "/> <usage value="The measure, as written, does not specifically require documentation of laterality. Coding limitations in particular clinical terminologies do not currently allow for that level of specificity (ICD-10-CM includes laterality, but SNOMED-CT does not uniformly include this distinction). Therefore, at this time, it is not a requirement of this measure to indicate laterality of the diagnoses, findings or procedures. Available coding to capture the data elements specified in this measure has been provided. It is assumed that the eligible clinician will record laterality in the patient medical record, as quality care and clinical documentation should include laterality. The communication of results, including the level of severity of diabetic retinopathy and presence or absence of macular edema to the primary care physician providing ongoing care of a patient's diabetes should be completed soon after the dilated exam is performed. Eligible clinicians reporting on this measure should note that all data for the measurement period is to be submitted by the deadline established by CMS. Therefore, eligible clinicians who see patients towards the end of the measurement period (i.e., December in particular), should communicate the results of the dilated macular exam as soon as possible in order for those patients to be counted in the measure numerator. Communicating the results as soon as possible after the date of the exam will ensure the data are included in the submission to CMS. This eCQM is a patient-based measure. Telehealth encounters are not eligible for this measure because the measure requires a clinical action that cannot be conducted via telehealth. This FHIR-based measure has been derived from the QDM-based measure CMS142v14. Please refer to the HL7 QI-Core Implementation Guide (https://hl7.org/fhir/us/qicore/STU6/) for more information on QI-Core and mapping recommendations from QDM to QI-Core STU 6 (https://hl7.org/fhir/us/qicore/STU6/qdm-to-qicore.html). "/> <copyright value="Copyright 2025 American Academy of Ophthalmology. All Rights Reserved. "/> <effectivePeriod> <start value="2026-01-01"/> <end value="2026-12-31"/> </effectivePeriod> <author> <name value="American Academy of Ophthalmology"/> <telecom> <system value="url"/> <value value="www.aao.org"/> </telecom> </author> <author> <name value="American Medical Association (AMA)"/> <telecom> <system value="url"/> <value value="https://www.ama-assn.org/"/> </telecom> </author> <relatedArtifact> <type value="citation"/> <citation value="Aiello, L. P., \& DCCT/EDIC Research Group (2014). Diabetic retinopathy and other ocular findings in the diabetes control and complications trial/epidemiology of diabetes interventions and complications study. Diabetes care, 37(1), 17--23. doi:10.2337/dc13-2251 "/> </relatedArtifact> <relatedArtifact> <type value="citation"/> <citation value="Lim, J.I., Kim, S.J., Bailey, S.T., Kovach, J.L., Vemulakonda, G.A., Ying, G., Flaxel, C.J. and the American Academy of Ophthalmology Preferred Practice Pattern Retina/Vitreous Committee (2025). Diabetic Retinopathy Preferred Practice Pattern. Ophthalmology. 2025 in press. doi: 10.1016/j.ophtha.2024.12.020 "/> </relatedArtifact> <relatedArtifact> <type value="citation"/> <citation value="Storey, P. P., Murchison, A. P., Pizzi, L. T., Hark, L. A., Dai, Y., Leiby, B. E., \& Haller, J. A. Impact of physician communication on diabetic eye examination adherence: Results from a Retrospective Cohort Analysis. Retina. 2016 Jan;36(1),20-7. doi:10.1097/IAE.0000000000000652 "/> </relatedArtifact> <relatedArtifact> <type value="citation"/> <citation value="Zhang, X., Saaddine, J. B., Chou, C. F., Cotch, M. F., Cheng, Y. J., Geiss, L. S., ... Klein, R. (2010). Prevalence of diabetic retinopathy in the United States, 2005-2008. JAMA, 304(6), 649--656. doi:10.1001/jama.2010.1111 "/> </relatedArtifact> <library value="https://madie.cms.gov/Library/CMS142FHIRCommWithDrManagingDiab"/> <disclaimer value="The Measure is not a clinical guideline, does not establish a standard of medical care, and has not been tested for all potential applications. The Measure, while copyrighted, can be reproduced and distributed, without modification, for noncommercial purposes, e.g., use by health care providers in connection with their practices. Commercial use is defined as the sale, license, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain. Commercial uses of the Measure require a license agreement between the user and the American Academy of Ophthalmology (Academy). Neither the Academy, its members, the American Medical Association (AMA), nor the former AMA-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI), nor PCPI, nor their members shall be responsible for any use of the Measure. The PCPI's and AMA's significant past efforts and contributions to the development and updating of the Measures are acknowledged. The National Committee for Quality Assurance's significant past efforts and contributions to the development and updating of the Measure is acknowledged. THE MEASURE AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND. Limited proprietary coding is contained in the Measure specifications for convenience. A license agreement must be entered prior to a third party's use of Current Procedural Terminology (CPT\[R\]) or other proprietary code set contained in the Measures. Any other use of CPT or other coding by the third party is strictly prohibited. The Academy, the AMA, and former members of the PCPI disclaim all liability for use or accuracy of any CPT or other coding contained in the specifications. CPT(R) contained in the Measure specifications is copyright 2004-2024 American Medical Association. LOINC(R) is copyright 2004-2024 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT\[R\]) copyright 2004-2024 International Health Terminology Standards Development Organisation. ICD-10 is copyright 2024 World Health Organization. All Rights Reserved. Due to technical limitations, registered trademarks are indicated by (R) or \[R\]. "/> <rationale value="Diabetic retinopathy is a prevalent complication of diabetes, estimated to affect 28.5% of diabetic patients in the US (Zhang et al., 2010). Diabetic retinopathy is a key indicator of systemic complications of diabetes (Zhang et al., 2010). Coordination of care between the eye care specialist and the physician managing a patient's ongoing diabetes care is essential in stemming the progression of vision loss. Communication from the eye care specialist to a primary care physician facilitates the exchange of information about the severity and progression of a patient's diabetic retinopathy, adherence to recommended ocular care, need for follow-up visits, and treatment plans (Storey et al., 2016). Data from the Diabetes Control and Complications Trial showed that diabetic treatment and maintenance of glucose control delays the onset and slows the progression of diabetic retinopathy (Aiello \& DCCT/EDIC Research Group, 2014). "/> <clinicalRecommendationStatement value="The ophthalmologist should refer patients with diabetes to a primary care physician or endocrinologist for appropriate management of their systemic condition and should communicate examination results to the physician managing the patient's ongoing diabetes care (Lim et al., 2025). A goal is to achieve optimal control of blood glucose, blood pressure, and other risk factors through close communication with the patient's primary care physician on the status of the DR and the need for optimal metabolic control (Lim et al,, 2025). Establishing a close partnership between the ophthalmologist and the primary care physician is an important step to ensure optimal patient care. Furthermore, it is important to help educate patients with diabetes as well as their primary care physician about the ophthalmologic implications of controlling blood glucose (as monitored by HbA1c) to as near to normal as is safely possible (Lim et al., 2025). "/> <group id="Group_1"> <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring"> <valueCodeableConcept> <coding> <system value="http://terminology.hl7.org/CodeSystem/measure-scoring"/> <code value="proportion"/> <display value="Proportion"/> </coding> </valueCodeableConcept> </extension> <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis"> <valueCode value="boolean"/> </extension> <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-type"> <valueCodeableConcept> <coding> <system value="http://terminology.hl7.org/CodeSystem/measure-type"/> <code value="process"/> <display value="Process"/> </coding> </valueCodeableConcept> </extension> <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-improvementNotation"> <valueCodeableConcept> <coding> <system value="http://terminology.hl7.org/CodeSystem/measure-improvement-notation"/> <code value="increase"/> <display value="Increased score indicates improvement"/> </coding> </valueCodeableConcept> </extension> <population id="InitialPopulation_1"> <code> <coding> <system value="http://terminology.hl7.org/CodeSystem/measure-population"/> <code value="initial-population"/> <display value="Initial Population"/> </coding> </code> <description value="All patients aged 18 years and older with a diagnosis of diabetic retinopathy during the measurement period "/> <criteria> <language value="text/cql-identifier"/> <expression value="Initial Population"/> </criteria> </population> <population id="Denominator_1"> <code> <coding> <system value="http://terminology.hl7.org/CodeSystem/measure-population"/> <code value="denominator"/> <display value="Denominator"/> </coding> </code> <description value="Equals Initial Population who had a dilated macular or fundus exam performed during the measurement period "/> <criteria> <language value="text/cql-identifier"/> <expression value="Denominator"/> </criteria> </population> <population id="Numerator_1"> <code> <coding> <system value="http://terminology.hl7.org/CodeSystem/measure-population"/> <code value="numerator"/> <display value="Numerator"/> </coding> </code> <description value="Patients with documentation, at least once within the measurement period, of the findings of the dilated macular or fundus exam via communication to the physician who manages the patient's diabetic care "/> <criteria> <language value="text/cql-identifier"/> <expression value="Numerator"/> </criteria> </population> <population id="DenominatorException_1"> <code> <coding> <system value="http://terminology.hl7.org/CodeSystem/measure-population"/> <code value="denominator-exception"/> <display value="Denominator Exception"/> </coding> </code> <description value="* Documentation of medical reason(s) for not communicating the findings of the dilated macular or fundus exam to the physician who manages the ongoing care of the patient with diabetes. * Documentation of patient reason(s) for not communicating the findings of the dilated macular or fundus exam to the physician who manages the ongoing care of the patient with diabetes. "/> <criteria> <language value="text/cql-identifier"/> <expression value="Denominator Exceptions"/> </criteria> </population> </group> <supplementalData id="sde-ethnicity"> <usage> <coding> <system value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/> <code value="supplemental-data"/> </coding> </usage> <description value="SDE Ethnicity "/> <criteria> <language value="text/cql-identifier"/> <expression value="SDE Ethnicity"/> </criteria> </supplementalData> <supplementalData id="sde-payer"> <usage> <coding> <system value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/> <code value="supplemental-data"/> </coding> </usage> <description value="SDE Payer "/> <criteria> <language value="text/cql-identifier"/> <expression value="SDE Payer"/> </criteria> </supplementalData> <supplementalData id="sde-race"> <usage> <coding> <system value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/> <code value="supplemental-data"/> </coding> </usage> <description value="SDE Race "/> <criteria> <language value="text/cql-identifier"/> <expression value="SDE Race"/> </criteria> </supplementalData> <supplementalData id="sde-sex"> <usage> <coding> <system value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/> <code value="supplemental-data"/> </coding> </usage> <description value="SDE Sex "/> <criteria> <language value="text/cql-identifier"/> <expression value="SDE Sex"/> </criteria> </supplementalData> </Measure>