dQM QICore Content Implementation Guide
2025.0.0 - CI Build

dQM QICore Content Implementation Guide, published by cqframework. This guide is not an authorized publication; it is the continuous build for version 2025.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/cqframework/dqm-content-qicore-2025/ and changes regularly. See the Directory of published versions

Measure: Closing the Referral Loop: Receipt of Specialist ReportFHIR

Official URL: https://madie.cms.gov/Measure/CMS50FHIRReceiptofSpecialistReport Version: 1.0.000
Active as of 2025-08-20 Responsible: Centers for Medicare & Medicaid Services (CMS) Computable Name: CMS50FHIRReceiptofSpecialistReport
Other Identifiers: Short Name: CMS50FHIR (use: usual, ), UUID:75691bbe-451e-4e3a-9a95-6361f7b45196 (use: official, ), UUID:00ad5281-ab7f-4e65-842f-b296dd094771 (use: official, ), Publisher: 50FHIR (use: official, )

Copyright/Legal: This electronic clinical quality measure (Measure) and related data specifications are owned and stewarded by the Centers for Medicare \& Medicaid Services (CMS). CMS contracted (Contract # 75FCMC18D0027/ Task Order #: 75FCMC24F0144) with the American Institutes for Research (AIR) to develop this electronic measure. AIR is not responsible for any use of the Measure. AIR makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and AIR has no liability to anyone who relies on such measures or specifications. Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. AIR disclaims all liability for use or accuracy of any third-party codes 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.

Percentage of patients with referrals, regardless of age, for which the referring clinician receives a report from the clinician to whom the patient was referred

Metadata
Title Closing the Referral Loop: Receipt of Specialist ReportFHIR
Version 1.0.000
Short Name CMS50FHIR
GUID (Version Independent) urn:uuid:75691bbe-451e-4e3a-9a95-6361f7b45196
GUID (Version Specific) urn:uuid:00ad5281-ab7f-4e65-842f-b296dd094771
CMS Identifier 50FHIR
Effective Period 2026-01-01 through 2026-12-31
Steward (Publisher) Centers for Medicare & Medicaid Services (CMS)
Developer American Institutes for Research (AIR)
Description

Percentage of patients with referrals, regardless of age, for which the referring clinician receives a report from the clinician to whom the patient was referred

Copyright

This electronic clinical quality measure (Measure) and related data specifications are owned and stewarded by the Centers for Medicare & Medicaid Services (CMS). CMS contracted (Contract # 75FCMC18D0027/ Task Order #: 75FCMC24F0144) with the American Institutes for Research (AIR) to develop this electronic measure. AIR is not responsible for any use of the Measure. AIR makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and AIR has no liability to anyone who relies on such measures or specifications. Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. AIR disclaims all liability for use or accuracy of any third-party codes 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.

Disclaimer

This performance 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 AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND. Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].

Rationale

Problems in the outpatient referral and consultation process have been documented, including inadequate care pathways between specialty and primary care. Studies suggest that both specialists and primary care providers (PCPs) are not satisfied with current processes (Institute for Healthcare Improvement / National Patient Safety Foundation, 2017; Greenwood-Lee et. al, 2018). Breakdowns in referral communication leads to worse health outcomes, increased cost, and appointment delays (Patel et. al, 2018; Odisho et. al, 2020). A 2018 analysis of primary care referrals to specialists found that of the 103,737 referral scheduling attempts analyzed, only 36,072 (34.8%) resulted in documented complete appointments, defined by the specialty clinician providing report to the PCP after the referral visit (Patel et. al, 2018). Technological and process-based updates can improve the referral loop process and increase rates of closing the referral loop. Ramelson et. al (2018) enhanced an EHR's Referral Manager module to meet the Controlled Risk Insurance Company’s best practice steps and the requirements of both the CMS EHR Incentive Program and the National Committee for Quality Assurance Patient-Centered Medical Home program. Following the updates, 76.8% of referrals were completed and all defined referral process steps were easier to accomplish. Odisho et. al (2020) developed a referrals automation software to simplify the fax to referral process. Feedback from key stakeholder interviews noted that the software enhanced the referrals process by further streamlining and organizing the patient referral process. The Institute for Healthcare Improvement and the National Patient Safety Foundation (2017) reviewed the referrals process in the ambulatory care setting and found that organizational leaders, EHR vendors, regulatory agencies, clinicians, and patients all play a role in creating a referrals system that is effective, safe, convenient, and patient-centered.

Clinical Recommendation Statement

None

Citation Greenwood-Lee, J., Jewett, L., Woodhouse, L., & Marshall, D. A. (2018). A categorisation of problems and solutions to improve patient referrals from primary to specialty care. BMC health services research, 18(1), 986. https://doi.org/10.1186/s12913-018-3745-y
Citation Institute for Healthcare Improvement / National Patient Safety Foundation. (2017). Closing the Loop: A Guide to Safer Ambulatory Referrals in the EHR Era. https://www.ihi.org/resources/Pages/Publications/Closing-the-Loop-A-Guide-to-Safer-Ambulatory-Referrals.aspx
Citation Odisho, A. Y., Lui, H., Yerramsetty, R., Bautista, F., Gleason, N., Martin, E., Young, J. J., Blum, M., & Neinstein, A. B. (2020). Design and development of referrals automation, a SMART on FHIR solution to improve patient access to specialty care. JAMIA open, 3(3), 405–412. https://doi.org/10.1093/jamiaopen/ooaa036
Citation Patel, M. P., Schettini, P., O'Leary, C. P., Bosworth, H. B., Anderson, J. B., & Shah, K. P. (2018). Closing the Referral Loop: an Analysis of Primary Care Referrals to Specialists in a Large Health System. Journal of general internal medicine, 33(5), 715–721. https://doi.org/10.1007/s11606-018-4392-z
Citation Ramelson, H., Nederlof, A., Karmiy, S., Neri, P., Kiernan, D., Krishnamurthy, R., Allen, A., & Bates, D. W. (2018). Closing the loop with an enhanced referral management system. Journal of the American Medical Informatics Association: JAMIA, 25(6), 715–721. https://doi.org/10.1093/jamia/ocy004
Definition Referral: A request from one clinician to another clinician for evaluation, treatment, or co-management of a patient's condition. This term encompasses referral and consultation as defined by Centers for Medicare & Medicaid Services.
Definition Report: A written document prepared by the eligible clinician (and staff) to whom the patient was referred and that accounts for his or her findings, provides summary of care information about findings, diagnostics, assessments and/or plans of care, and is provided to the referring eligible clinician.
Guidance (Usage)

The clinician who refers the patient to another clinician is the clinician who should be held accountable for the performance of this measure. Only the first referral made between January 1 – October 31 of the measurement period will be considered for this measure to allow adequate time for the referring clinician to collect the consult report by the end of the measurement period. If there are multiple referrals for a patient during the measurement period, use the first referral. The clinician to whom the patient was referred is responsible for sending the consultant report that will fulfill the communication. Note: this is not the same clinician who would report on the measure. The consultant report that will successfully close the referral loop should be related to the first referral for a patient during the measurement period. If there are multiple consultant reports received by the referring clinician which pertain to a particular referral, use the first consultant report to satisfy the measure. 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 refer patients towards the end of the measurement period (i.e., October), should request that clinicians to whom they referred their patients share their consult reports as soon as possible in order for those patients to be counted in the measure numerator during the measurement period. When clinicians to whom patients are referred communicate the consult report as soon as possible with the referring clinician, it ensures that the communication loop is closed in a timely manner and that the data are included in the submission to CMS. A procedural report received from a specialist for an exam or procedure conducted (e.g., diabetic eye exam, colonoscopy, etc.) can satisfy the numerator requirement and successfully close the referral loop. A separate consultant note or consultant report is not required to close the referral loop in these circumstances. This eCQM is a patient-based measure. This FHIR-based measure has been derived from the QDM-based measure: CMS50v14. 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 6.0.0 (https://hl7.org/fhir/us/qicore/STU6/qdm-to-qicore.html).

Measure Group (Rate) (ID: Group_1)
Summary

Percentage of patients with referrals, regardless of age, for which the referring clinician receives a report from the clinician to whom the patient was referred

Basis boolean
Scoring [http://terminology.hl7.org/CodeSystem/measure-scoring#proportion: 'Proportion']
Type [http://terminology.hl7.org/CodeSystem/measure-type#process: 'Process']
Rate Aggregation None
Improvement Notation [http://terminology.hl7.org/CodeSystem/measure-improvement-notation#increase: 'Increased score indicates improvement']
Initial Population ID: InitialPopulation_1
Description:

Number of patients, regardless of age, who had an encounter during the measurement period and were referred by one clinician to another clinician on or before October 31

Logic Definition: Initial Population
Denominator ID: Denominator_1
Description:

Equals Initial Population

Logic Definition: Denominator
Numerator ID: Numerator_1
Description:

Number of patients with a referral on or before October 31, for which the referring clinician received a report from the first clinician to whom the patient was referred

Logic Definition: Numerator
Supplemental Data Guidance 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: [http://terminology.hl7.org/CodeSystem/measure-data-usage#supplemental-data]
Description: SDE Ethnicity
Logic Definition: SDE Ethnicity
Supplemental Data Element ID: sde-payer
Usage Code: [http://terminology.hl7.org/CodeSystem/measure-data-usage#supplemental-data]
Description: SDE Payer
Logic Definition: SDE Payer
Supplemental Data Element ID: sde-race
Usage Code: [http://terminology.hl7.org/CodeSystem/measure-data-usage#supplemental-data]
Description: SDE Race
Logic Definition: SDE Race
Supplemental Data Element ID: sde-sex
Usage Code: [http://terminology.hl7.org/CodeSystem/measure-data-usage#supplemental-data]
Description: SDE Sex
Logic Definition: SDE Sex
Measure Logic
Primary Library https://madie.cms.gov/Library/CMS50FHIRReceiptofSpecialistReport
Contents Population Criteria
Logic Definitions
Terminology
Dependencies
Data Requirements
Population Criteria
Measure Group (Rate) (ID: Group_1)
Initial Population
define "Initial Population":
  ( "Has Encounter during Measurement Period"
      or "Has Intervention during Measurement Period"
  )
    and "First Referral during First 10 Months of Measurement Period" is not null
Denominator
define "Denominator":
  "Initial Population"
Numerator
define "Numerator":
  "Referring Clinician Receives Consultant Report to Close Referral Loop"
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":
  [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: CMS50FHIRReceiptofSpecialistReport
define "SDE Sex":
  SDE."SDE Sex"
Logic Definition Library Name: CMS50FHIRReceiptofSpecialistReport
define "First Referral during First 10 Months of Measurement Period":
  First([ServiceRequest: "Referral"] ReferralOrder
      where ReferralOrder.status in { 'active', 'completed' }
        and ReferralOrder.intent = 'order'
        and ReferralOrder.authoredOn during day of Interval[start of "Measurement Period", Date(year from start of "Measurement Period", 10, 31)]
      sort by authoredOn ascending
  )
Logic Definition Library Name: CMS50FHIRReceiptofSpecialistReport
define "Referring Clinician Receives Consultant Report to Close Referral Loop":
  exists ( [Task: QICoreCommon."Fulfill"] ConsultantReportObtained
      with "First Referral during First 10 Months of Measurement Period" FirstReferral
        // TODO: discuss with vendors .focus vs .basedOn
        
        such that ( ConsultantReportObtained.focus.references ( FirstReferral )
            or ConsultantReportObtained.basedOn.references ( FirstReferral )
        )
          and ConsultantReportObtained.executionPeriod ends after FirstReferral.authoredOn
          and ConsultantReportObtained.executionPeriod ends during day of "Measurement Period"
          and ConsultantReportObtained.status = 'completed'
          and ConsultantReportObtained.reasonCode in "Consultant Report"
            /*
            TODO: discuss usage of Composition resource for "Consultant Report"
            NOTE: the following does not currently work due to "Composition" missing a profile in QICore
            and exists(
              ConsultantReportObtained.output.value OV 
                with ([Composition] ReportComposition where ReportComposition.type in "Consultant Report") ConsultantReportComposition 
                  such that (OV as Reference).references(ConsultantReportComposition)
            )
            */
  
  )
Logic Definition Library Name: CMS50FHIRReceiptofSpecialistReport
define "Numerator":
  "Referring Clinician Receives Consultant Report to Close Referral Loop"
Logic Definition Library Name: CMS50FHIRReceiptofSpecialistReport
define "Has Encounter during Measurement Period":
  exists ( ( ["Encounter": "Office Visit"]
      union ["Encounter": "Ophthalmological Services"]
      union ["Encounter": "Preventive Care Services Established Office Visit, 18 and Up"]
      union ["Encounter": "Preventive Care Services, Initial Office Visit, 0 to 17"]
      union ["Encounter": "Preventive Care Services Initial Office Visit, 18 and Up"]
      union ["Encounter": "Preventive Care, Established Office Visit, 0 to 17"] ) ValidEncounter
      where ValidEncounter.status = 'finished'
        and ValidEncounter.period during day of "Measurement Period"
  )
Logic Definition Library Name: CMS50FHIRReceiptofSpecialistReport
define "Has Intervention during Measurement Period":
  exists ( ( ( ["Procedure": "Behavioral/Neuropsych Assessment"]
        union ["Procedure": "Health behavior assessment, or re-assessment (ie, health-focused clinical interview, behavioral observations, clinical decision making)"]
        union ["Procedure": "Psychological or neuropsychological test administration and scoring by physician or other qualified health care professional, two or more tests, any method; first 30 minutes"]
        union ["Procedure": "Psychological or neuropsychological test administration and scoring by technician, two or more tests, any method; first 30 minutes"]
        union ["Procedure": "Psychotherapy for crisis; first 60 minutes"]
        union ["Procedure": "Psych Visit Diagnostic Evaluation"]
        union ["Procedure": "Developmental test administration (including assessment of fine and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed), by physician or other qualified health care professional, with interpretation and report; first hour"]
    ).isProcedurePerformed ( ) ) ValidIntervention
      where ValidIntervention.performed.toInterval ( ) during day of "Measurement Period"
  )
Logic Definition Library Name: CMS50FHIRReceiptofSpecialistReport
define "Initial Population":
  ( "Has Encounter during Measurement Period"
      or "Has Intervention during Measurement Period"
  )
    and "First Referral during First 10 Months of Measurement Period" is not null
Logic Definition Library Name: CMS50FHIRReceiptofSpecialistReport
define "Denominator":
  "Initial Population"
Logic Definition Library Name: CMS50FHIRReceiptofSpecialistReport
define "SDE Payer":
  SDE."SDE Payer"
Logic Definition Library Name: CMS50FHIRReceiptofSpecialistReport
define "SDE Ethnicity":
  SDE."SDE Ethnicity"
Logic Definition Library Name: CMS50FHIRReceiptofSpecialistReport
define "SDE Race":
  SDE."SDE Race"
Logic Definition Library Name: Status
//Procedure, Performed
define fluent function isProcedurePerformed(Proc List<Procedure>):
  Proc P
    where P.status ~ 'completed'
Logic Definition Library Name: QICoreCommon
/*
@description: Returns true if the given reference is to the given resource
@comment: Returns true if the `id` element of the given resource exactly equals the tail of the given reference.
NOTE: This function assumes resources from the same source server.
*/
define fluent function references(reference Reference, resource Resource):
  resource.id = Last(Split(reference.reference, '/'))
Logic Definition Library Name: QICoreCommon
/*
@description: Returns true if any of the given references are to the given resource
@comment: Returns true if the `id` element of the given resource exactly equals the tail of any of the given references.
NOTE: This function assumes resources from the same source server.
*/
define fluent function references(references List<Reference>, resource Resource):
  exists (references R where R.references(resource))
Logic Definition Library Name: QICoreCommon
/*
@description: Normalizes a value that is a choice of timing-valued types to an equivalent interval
@comment: Normalizes a choice type of DateTime, Quanitty, Interval<DateTime>, or Interval<Quantity> 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 QICore, allowing this function to be used across any resource.
The input can be provided as a DateTime, Quantity, Interval<DateTime> or Interval<Quantity>.
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 Quantity, the quantity is expected to be a calendar-duration interpreted as an Age,
and the result is a DateTime Interval beginning on the Date the patient turned that age and ending immediately before one year later.
If the input is a DateTime Interval, the result is the input.
If the input is a Quantity Interval, the quantities are expected to be calendar-durations interpreted as an Age, and the result
is a DateTime Interval beginning on the date the patient turned the age given as the start of the quantity interval, and ending
immediately before one year later than the date the patient turned the age given as the end of the quantity interval.
If the input is a Timing, an error will be thrown indicating that Timing calculations are not implemented. Any other input will reslt in a null DateTime Interval
*/
define fluent function toInterval(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>, Timing>):
  case
	  when choice is DateTime then
    	Interval[choice as DateTime, choice as DateTime]
		when choice is Interval<DateTime> then
  		choice as Interval<DateTime>
		when choice is Quantity then
		  Interval[Patient.birthDate + (choice as Quantity),
			  Patient.birthDate + (choice as Quantity) + 1 year)
		when choice is Interval<Quantity> then
		  Interval[Patient.birthDate + (choice.low as Quantity),
			  Patient.birthDate + (choice.high as Quantity) + 1 year)
		when choice is Timing then
      Message(null, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a Timing value is not supported') as Interval<DateTime>
		else
			null as Interval<DateTime>
	end
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
/*
@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
        }
Terminology
Code System Description: Code system SNOMEDCT
Resource: http://snomed.info/sct
Canonical URL: http://snomed.info/sct
Code System Description: Code system TaskCodeSystem
Resource: http://hl7.org/fhir/CodeSystem/task-code
Canonical URL: http://hl7.org/fhir/CodeSystem/task-code
Code System Description: Code system CPT
Resource: http://www.ama-assn.org/go/cpt
Canonical URL: http://www.ama-assn.org/go/cpt
Value Set Description: Value set Referral
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1046
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1046
Value Set Description: Value set Consultant Report
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.121.12.1006
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.121.12.1006
Value Set Description: Value set Office Visit
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001
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: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1285
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1285
Value Set Description: Value set Preventive Care Services Established Office Visit, 18 and Up
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1025
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1025
Value Set Description: Value set Preventive Care Services, Initial Office Visit, 0 to 17
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1022
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1022
Value Set Description: Value set Preventive Care Services Initial Office Visit, 18 and Up
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1023
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1023
Value Set Description: Value set Preventive Care, Established Office Visit, 0 to 17
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1024
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1024
Value Set Description: Value set Behavioral/Neuropsych Assessment
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1023
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1023
Value Set Description: Value set Psych Visit Diagnostic Evaluation
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1492
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1492
Value Set Description: Value set Payer Type
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591
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: Fulfill
Code: fulfill
System: http://hl7.org/fhir/CodeSystem/task-code
Direct Reference Code Display: Health behavior assessment, or re-assessment (ie, health-focused clinical interview, behavioral observations, clinical decision making)
Code: 96156
System: http://www.ama-assn.org/go/cpt
Direct Reference Code Display: Psychological or neuropsychological test administration and scoring by physician or other qualified health care professional, two or more tests, any method; first 30 minutes
Code: 96136
System: http://www.ama-assn.org/go/cpt
Direct Reference Code Display: Psychological or neuropsychological test administration and scoring by technician, two or more tests, any method; first 30 minutes
Code: 96138
System: http://www.ama-assn.org/go/cpt
Direct Reference Code Display: Psychotherapy for crisis; first 60 minutes
Code: 90839
System: http://www.ama-assn.org/go/cpt
Direct Reference Code Display: Developmental test administration (including assessment of fine and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed), by physician or other qualified health care professional, with interpretation and report; first hour
Code: 96112
System: http://www.ama-assn.org/go/cpt
Dependencies
Dependency Description: QICore model information
Resource: http://hl7.org/fhir/Library/QICore-ModelInfo
Canonical URL: http://hl7.org/fhir/Library/QICore-ModelInfo
Dependency Description: Library SDE
Resource: https://madie.cms.gov/Library/SupplementalDataElements|5.1.000
Canonical URL: https://madie.cms.gov/Library/SupplementalDataElements|5.1.000
Dependency Description: Library FHIRHelpers
Resource: https://madie.cms.gov/Library/FHIRHelpers|4.4.000
Canonical URL: https://madie.cms.gov/Library/FHIRHelpers|4.4.000
Dependency Description: Library QICoreCommon
Resource: https://madie.cms.gov/Library/QICoreCommon|4.0.000
Canonical URL: https://madie.cms.gov/Library/QICoreCommon|4.0.000
Dependency Description: Library Status
Resource: https://madie.cms.gov/Library/Status|1.15.000
Canonical URL: https://madie.cms.gov/Library/Status|1.15.000
Data Requirements
Data Requirement Type: Patient
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient
Must Support Elements: extension, birthDate, birthDate.value, url
Data Requirement Type: ServiceRequest
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-servicerequest
Must Support Elements: code, status, status.value, intent, intent.value, authoredOn, authoredOn.value
Code Filter(s):
Path: code
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1046
Data Requirement Type: Resource
Profile(s): http://hl7.org/fhir/StructureDefinition/Resource
Must Support Elements: id, id.value
Data Requirement Type: Task
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-task
Must Support Elements: code, focus, basedOn, executionPeriod, status, status.value, reasonCode
Code Filter(s):
Path: code
Code(s): http://hl7.org/fhir/CodeSystem/task-code#fulfill: 'Fulfill'
Data Requirement Type: Encounter
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
Must Support Elements: type, status, status.value, period
Code Filter(s):
Path: type
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001
Data Requirement Type: Encounter
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
Must Support Elements: type, status, status.value, period
Code Filter(s):
Path: type
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1285
Data Requirement Type: Encounter
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
Must Support Elements: type, status, status.value, period
Code Filter(s):
Path: type
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1025
Data Requirement Type: Encounter
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
Must Support Elements: type, status, status.value, period
Code Filter(s):
Path: type
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1022
Data Requirement Type: Encounter
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
Must Support Elements: type, status, status.value, period
Code Filter(s):
Path: type
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1023
Data Requirement Type: Encounter
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
Must Support Elements: type, status, status.value, period
Code Filter(s):
Path: type
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1024
Data Requirement Type: Procedure
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure
Must Support Elements: code, status, status.value, performed
Code Filter(s):
Path: code
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1023
Data Requirement Type: Procedure
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure
Must Support Elements: code, status, status.value, performed
Code Filter(s):
Path: code
Code(s): http://www.ama-assn.org/go/cpt#96156: 'Health behavior assessment, or re-assessment (ie, health-focused clinical interview, behavioral observations, clinical decision making)'
Data Requirement Type: Procedure
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure
Must Support Elements: code, status, status.value, performed
Code Filter(s):
Path: code
Code(s): http://www.ama-assn.org/go/cpt#96136: 'Psychological or neuropsychological test administration and scoring by physician or other qualified health care professional, two or more tests, any method; first 30 minutes'
Data Requirement Type: Procedure
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure
Must Support Elements: code, status, status.value, performed
Code Filter(s):
Path: code
Code(s): http://www.ama-assn.org/go/cpt#96138: 'Psychological or neuropsychological test administration and scoring by technician, two or more tests, any method; first 30 minutes'
Data Requirement Type: Procedure
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure
Must Support Elements: code, status, status.value, performed
Code Filter(s):
Path: code
Code(s): http://www.ama-assn.org/go/cpt#90839: 'Psychotherapy for crisis; first 60 minutes'
Data Requirement Type: Procedure
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure
Must Support Elements: code, status, status.value, performed
Code Filter(s):
Path: code
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1492
Data Requirement Type: Procedure
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure
Must Support Elements: code, status, status.value, performed
Code Filter(s):
Path: code
Code(s): http://www.ama-assn.org/go/cpt#96112: 'Developmental test administration (including assessment of fine and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed), by physician or other qualified health care professional, with interpretation and report; first hour'
Data Requirement Type: Coverage
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-coverage
Must Support Elements: type, period
Code Filter(s):
Path: type
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591
Generated using version 0.4.8 of the sample-content-ig Liquid templates