What are the exclusions for Meaningful Use?

What is an exclusion?

Exclusions are CMS specified exemptions from completing certain criteria and can be claimed during attestation. If you qualify for an exclusion, you do not need to complete  that measure and you can still receive a full incentive payment or avoid penalties if you achieve all of the remaining objectives.


When and where do I claim an exclusion?

Exclusions will be claimed during attestation (e.g. when completing the online attestation process with CMS or your state Medicaid agency) at the end of your reporting period.


What are the exclusions for my specialty?

Some exclusion definitions may be universally or nearly universally applicable to a specialty due to their scope of practice. However, because there is no blanket exclusion for any type of provider, specialists must individually evaluate whether they meet the exclusion criteria for each applicable measure.


Maintaining documentation of your exclusions

You will not need to submit any documentation to CMS or Medicaid during the attestation process to claim an exclusion. However, you need to be prepared to prove you qualify for an exclusion in case of an audit; this means you should retain any documentation that supports your qualification for the exclusion. This documentation could be email exchanges with CMS or Medicaid, information that confirms your specialty or practice locations, etc. For some measures, the Meaningful Use Dashboard will display a value of zero for the denominator if you do not see any patients who meet the criteria. You should maintain a copy (screenshot or printed copy) of your Meaningful Use Dashboard with those values if you claim an exclusion for those measures.


There are exclusions for several Meaningful Use criteria. We cannot confirm whether you are eligible for an exclusion, but we can help you understand the requirements. You must make this decision in consultation with CMS, if necessary. Contact your regional CMS representatives for questions pertaining to Meaningful Use exclusions.


The following is a list of Stage 2 measures and their associated exclusions. Please read each exclusion carefully to understand if it applies to you:


Objective 1: Protect Patient Health Information

  • No available exclusions


Objective 2: Clinical Decision Support

  • Exclusion: Any eligible provider who writes fewer than 100 medication orders during the EHR reporting period is excluded from the second measure of this objective (enabling drug-drug and drug-allergy interaction checks).


Objective 3: Computerized Provider Order Entry (CPOE)

  • Exclusion: Any provider who writes fewer than 100 medication, radiology, and/or laboratory orders during the EHR reporting period is excluded from the corresponding measure.

  • Alternate Exclusion: Providers who began Meaningful Use in 2015 or 2016 have the option to claim an alternate exclusion for measure 2 (laboratory orders) and measure 3 (radiology orders).

Objective 4: Electronic Prescribing (eRx)

  • Exclusion: Any provider who:

  • Writes fewer than 100 prescriptions during the EHR reporting period

  • Doesn’t have a pharmacy within their organization and there are no pharmacies that accept electronic prescriptions within 10 miles of the practice location at the start of the reporting period.


Objective 5: Health Information Exchange

  • Exclusion: Any EP who transfers a patient to another setting or refers a patient to another provider less than 100 times during the EHR reporting period is excluded from this objective.


Objective 6: Patient Specific Education

  • Exclusion: Any EP who has no office visits during the EHR reporting period.


Objective 7: Medication Reconciliation

  • Exclusion: Any EP who was not the recipient of any transitions of care during the EHR reporting period is excluded from this measure.


Objective 8: Patient Electronic Access

  • Exclusion: Any provider who:

  • Doesn’t order or create any of the information listed for inclusion as part of both measures.

  • Conducts 50 percent or more of his or her patient encounters in a county that does not have 50 percent or more of its housing units with 4Mbps broadband availability according to the latest information available from the FCC on the first day of the EHR reporting period.


Objective 9: Secure Electronic Messaging

  • Exclusion: Any EP who has no office visits during the EHR reporting period, or any EP who conducts 50 percent or more of his or her patient encounters in a county that does not have 50 percent or more of its housing  units with 4Mbps broadband availability according to the latest information available from the FCC on the first day of the EHR reporting period.


Objective 10: Public Health

  • Exclusion for Measure 1 Immunization Registry: Any eligible provider meeting one or more of the following criteria may be excluded from the immunization registry reporting sub-measure if the eligible provider:

  • Does not administer any immunizations to any of the populations for which data is collected by its jurisdiction's immunization registry or immunization information system during the EHR reporting period.

  • Operates in a jurisdiction for which no immunization registry or immunization information system is capable of accepting the specific standards required to meet the CEHRT definition at the start of the EHR reporting period

  • Operates in a jurisdiction where no immunization registry or immunization information system has declared readiness to receive immunization data from the EP at the start of the EHR reporting period.

  • Exclusion for Measure 2 Syndromic Surveillance: Any eligible provider meeting one or more of the following criteria may be excluded from the syndromic surveillance reporting measure if the provider:

  • Is not in a category of providers from which ambulatory syndromic surveillance data is collected by their jurisdiction's syndromic surveillance system;

  • Operates in a jurisdiction for which no public health agency is capable of receiving electronic syndromic surveillance data in the specific standards required by CEHRT at the start of their EHR reporting period;

  • Operates in a jurisdiction where no public health agency has declared readiness to receive syndromic surveillance data from EPs at the start of the EHR reporting period.

  • Exclusion for Measure 3 Specialized Registry Reporting: Any eligible professional (EP) that meets at least 1 of the following criteria may be excluded from this objective:

  • Does not diagnose or treat any disease or condition associated with or collect relevant data that is required by a specialized registry in their jurisdiction during the EHR reporting period.

  • Operates in a jurisdiction for which no specialized registry is capable of accepting electronic registry transactions in the specific standards required to meet the CEHRT definition at the start of the EHR reporting period.

  • Operates in a jurisdiction where no specialized registry for which the EP, eligible hospital, or CAH is eligible has declared readiness to receive electronic registry transactions at the beginning of the EHR reporting period.

  • Exclusion updates for 2016: Providers should be able to claim an alternate exclusion to both Syndromic Surveillance and Specialized Registry Reporting, 2 of the 3 measures for Objective 10. If providers immunize patients, they will need to complete the Immunization Registry Reporting requirements. If they do not immunize patients, then they will claim an exclusion to all three measures to meet the overall objective. Please see  FAQ #14397 and  FAQ #14401 for more details, and contact CMS if you have additional questions.



Meaningful Use & PQRS

  1. How do I start Meaningful Use?
  2. Where do I access the Meaningful Use dashboard and PQRS Clinical Quality Measures (CQM) report?
  3. How does the Meaningful Use Dashboard work?
  4. How do I attest for Meaningful Use?
  5. What are the Modified Stage 2 Meaningful Use requirements?
  6. What are the Stage 2 Meaningful Use requirements?
  7. What are the exclusions for Meaningful Use?
  8. How can I report CQMs for PQRS?
  9. How do I achieve Stage 2 Core Measure 10: Clinical Lab Test Results?
  10. What patients are counted for Meaningful Use?
  11. How do the components of a chart note relate to Meaningful Use?
  12. How do lab and image ordering relate to Meaningful Use?
  13. Confirmatory Consultation Report or Clinical Consultation Report
  14. How do I export a patient record (clinical document)?
  15. How do I print the Meaningful Use Dashboard?
  16. How do I achieve Stage 1 Menu Measure 2: Lab test results as structured data?
  17. How do I minimize or refresh CDS notifications?
  18. How can I send a referral using Direct Messaging?
  19. What is MACRA: Merit-based Incentive Payment System (MIPS)?
  20. What is MACRA: Comprehensive Primary Care Plus (CPC+)?
  21. What are the Advancing Care Information (ACI) measures for MIPS and how are they scored?
  22. What are the Quality measure reporting requirements for MIPS?
  23. CQM: Cervical Cancer Screening (CMS 124v4/NQF 0032)
  24. CQM: Pneumonia Vaccination Status for Older Adults (CMS 127v4/NQF 0043)
  25. How do I achieve the Stage 1 Core Measure: Clinical Summaries?
  26. CQM: Preventive Care and Screening: Influenza Immunization (CMS 147v5/NQF 0041)
  27. How do I achieve Stage 2 Objective 8: Patient Electronic Access?
  28. How do I achieve Stage 1 Core Measure 6: Drug Allergy List?
  29. CQM: Diabetes: Foot Exam (CMS123v4/ NQF 0056)
  30. How do I achieve Stage 1 Menu Measure 3: Patient Lists Report?
  31. How do I achieve Stage 2 Menu Objective 4: Family Health History?
  32. How does patient portal access and auto-invite relate to Meaningful Use?
  33. CQM: Closing the Referral Loop: Receipt of Specialist Report (CMS50v4/NQF N/A)
  34. How do I achieve Stage 1 Core Measure 9: Smoking Status?
  35. How do I achieve Stage 1 Core Measure 7: Record demographics?
  36. How do I achieve Stage 1 Core Measure 3: Maintain problem list?
  37. How do I achieve Stage 2 Menu Measure 2: Electronic Notes?
  38. How do I achieve Stage 2 Core Measure 8: Clinical Summaries?
  39. How do I achieve Stage 2 Core Measure 3: Record Demographics?
  40. How do I achieve Stage 2 Objective 9: Secure Electronic Messaging?
  41. How do I achieve Stage 2 Objective 2: Clinical Decision Support?
  42. How do I achieve Stage 2 Core Measure 12: Preventative Care?
  43. How do I achieve Stage 1 Core Measure 2: Drug interaction checks?
  44. How do I achieve the Stage 1 Core Measure 11: Patient Electronic Access?
  45. How do I achieve Stage 1 Menu Measure: Syndromic Surveillance Data Submission
  46. How do I achieve Stage 1 Menu Measure 4: Patient Reminders?
  47. CQM: Use of High-Risk Medications in the Elderly (CMS156v4/ NQF 0022)
  48. How do I achieve Stage 1 Menu 6: Patient-specific Education
  49. What constitutes a "unique" patient?
  50. Meaningful Use attestation for previous years
  51. How do I achieve Stage 1 Core Measure 4: e-Prescribe (eRx)?
  52. How do I achieve Stage 2 Menu Measure 3: Imaging Results?
  53. How do I achieve Stage 2 Objective 3: CPOE for Medication, Lab, and Radiology Orders?
  54. Will we be able to report PQRS through Practice Fusion in 2014?
  55. CQM: Diabetes: Low Density Lipoprotein (LDL) Management (CMS 163v3/ NQF 0064)
  56. CQM: Diabetes: Hemoglobin A1c Poor Control (CMS122v4/NQF 0059)
  57. CQM: Ischemic Vascular Disease (IVD): Complete Lipid Panel and LDL Control (CMS 182v4/NQF 0075)
  58. How do I achieve Stage 2 Objective 10: Public Health - Specialized Registry Reporting?
  59. CQM: Dementia: Cognitive Assessment (CMS 149v4)
  60. How do I avoid Meaningful Use penalties?
  61. CQM: Use of Imaging Studies for Low Back Pain (CMS166v5 / NQF 0052)
  62. CQM: Falls: Screening for Future Fall Risk (CMS 139v4/NQF 0101)
  63. How is CPOE for medication orders different from eRx?
  64. CQM: Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) (CMS 144v4/NQF 0083)
  65. How do I apply for a Meaningful Use Hardship Exception?
  66. How do I achieve Stage 1 Core Measure 8: Vital Signs?
  67. CQM: Use of Appropriate Medications for Asthma (CMS 126v3/ NQF0036)
  68. How do I achieve Stage 2 Menu Measure 5: Report Cancer Cases
  69. How do I achieve the Stage 1 Menu Measure 6: Medication Reconciliation?
  70. CQM: Colorectal Cancer Screening (CMS130v4/ NQF 0034)
  71. CQM: Chlamydia Screening for Women (CMS 153v4/NQF 0033)
  72. CQM: Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents (CMS 155v4/NQF 0024)
  73. How do I achieve Stage 2 Objective 7: Medication Reconciliation?
  74. CQM: Breast Cancer Screening (CMS 125v4/NQF N/A)
  75. CQM: Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented (CMS22v4, NQF: N/A)
  76. CQM: Diabetes: Eye Exam (CMS131v4 / NQF 0055)
  77. How do I achieve Stage 1 Menu Measure 1: Drug Formulary Checks?
  78. CQM: Functional Status Assessment for Complex Chronic Conditions (CMS90v5/ NQF N/A)
  79. CQM: Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention (CMS138v3 / NQF 0028)
  80. How do I achieve Stage 2 Objective 5: Health Information Exchange?
  81. How do I achieve the Stage 1 Core Measure 10: Clinical Decision Support?
  82. How do I achieve Stage 1 Menu Measure 7: Transition of Care Summary?
  83. CQM: Preventive Care and Screening: Screening for Clinical Depression and Follow-Up Plan (CMS2v5 / NQF 0418)
  84. CQM: Controlling High Blood Pressure (CMS165v4 / NQF 0018)
  85. CQM: Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up (CMS69v4 / NQF 0421)
  86. CQM: Documentation of Current Medications in the Medical Record (CMS68v5 / NQF 0419)
  87. How do I achieve Stage 2 Objective 1: Protect Electronic Health Information?
  88. What is Practice Fusion's certification number (ID)?
  89. CQM: Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic (CMS 164v4/NQF 0068)
  90. How do I register for Meaningful Use?
  91. How does the 2014 Clinical Quality Measure (CQM) Report work?
  92. Can I change, modify, or cancel my attestation?
  93. How do I choose my reporting period duration for Meaningful Use?
  94. Am I eligible for Meaningful Use?
  95. How do I calculate percentages for Meaningful Use with multiple EHRs?
  96. Starting what date must labs be ordered for Medicare Meaningful Use?
  97. How do I achieve Stage 2 Core Measure 5: Record Smoking Status?
  98. How do I achieve the Stage 1 Core Measure 13: Protect Electronic Health Information?
  99. How do I achieve Stage 2 Objective 4: Electronic Prescribing (eRx)?
  100. How do I meet the Stage 1 Menu Measure 9: Immunization Data Submission?
  101. How do I achieve Stage 2 Objective 10: Public Health - Immunization Registry Data Submission?
  102. Qualifying Meaningful Use Measures as a Physician Assistant
  103. Is Practice Fusion certified as a 2014 Meaningful Use Complete EHR?
  104. Patient records maintained in the EHR for Meaningful Use attestation
  105. What are the 2014 Meaningful Use flexibility changes?
  106. How do I get my AIU letter from Practice Fusion?
  107. Do I have to attest yearly to receive the additional payments?
  108. How do I report Clinical Quality Measures for Meaningful Use?
  109. How do I achieve Stage 2 Objective 6: Patient Specific Education?
  110. Without cancer registry and report specific cases module, how is Practice fusion certified for Meaningful Use?
  111. How do I achieve Stage 1 Core Measure 1: CPOE for Medication Orders?
  112. How do I achieve Stage 1 Core Measure 5: Maintain Medication List?
  113. How do I achieve Stage 2 Core Measure 11: Patient Lists?
  114. Do I have to meet all of the measures to achieve Meaningful Use?
  115. Can I switch between the Medicare and Medicaid EHR Incentive Programs?
  116. How to Chart EMGs for Meaningful Use?
  117. Are there patient education materials available in Spanish?
  118. How do I select or change my reporting period start date?
  119. How do I achieve Stage 2 Core Measure 4: Record Vital Signs?
  120. When do I need to sign chart notes for Meaningful Use? Can I sign a chart after the reporting period?
  121. How do I contact CMS about the EHR Incentive Program?
  122. Is an integration with imaging centers required for Stage 2 of Meaningful Use?
  123. What is QCDR?
  124. How do I qualify for the Medicaid incentive?
  125. What Stage am I in if I skip a year of Meaningful Use?
  126. How much are the Meaningful Use incentives?
  127. How do I qualify for Meaningful Use if I see patients in multiple locations?
  128. How many exclusions can each provider claim for meaningful use?
  129. Are Meaningful Use payments affected by sequestration?
  130. What is Meaningful Use?
  131. Can I use multiple EHR's to qualify for Meaningful Use?
  132. How do I achieve Stage 2 Objective 10: Public Health - Syndromic Surveillance Data Submission?
  133. How does the PQRS Clinical Quality Measures dashboard work?
  134. Does Practice Fusion support Patient-Centered Medical Home (PCMH)?
  135. Stage 2 Objective 10: Public Health
  136. What stage of Meaningful Use am I in?
  137. How do I prepare for the PQRS Penalty Informal Review?
  138. How do I prepare for a Meaningful Use audit?
  139. What is Data Portability?

Feedback and Knowledge Base


Still need help?

Create a help ticket