eCQM: Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%) (CMS 122v5)


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


CMS 122v5

Measure Type:

Intermediate Outcome

MIPS High Priority Measure:


Quality ID:


Eligible for Quality Programs:

  • Merit-Based Incentive Payment System (MIPS)
  • Medicaid EHR Incentive Program (Meaningful Use)
  • Comprehensive Primary Care Plus (CPC+)

Performance Benchmark for MIPS:

0 % (Zero Percent*) This eCQM is an inverse measure, which means a lower performance rate indicates better performance. In Practice Fusion’s eCQM Dashboard, the EHR displays an inverse performance rate for this measure to make it easier to quickly see how you are performing. This means that the measure percentage will increase as the measure numerator decreases. Specifically, a higher measure percentage and lower measure numerator are an indicator of better measure performance.


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

  • Numerator: Patients from the denominator whose most recent HbA1c level (performed during the measurement period) is > 9.0%.

  • Denominator: Patients 18-75 years of age with diabetes with an eligible visit (chart notes with one of the following encounter types: Office Visit, Nursing Home Visit, Nurse Visit or Home Visit) during the measurement period.

    • Denominator Exclusions: None

    • Denominator Exceptions: None

eCQM Patient Reports

eCQM Patient Reports can help you identify patient care gaps and improve the performance of your quality measures. Click on the blue result numbers in the eCQM Dashboard to see the patient report for this measure.

The eCQM Patient Reports list the individual patients included in the measure’s population, which measure cohorts the patient is in, and contact information for the patient to streamline any downstream communication that may be needed to fulfill the measure requirements. You can choose to print the patient list for a measure or export it as a CSV.

The measure cohorts included in the eCQM Patient Report for CMS 122v5 Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%) are:

  • Initial patient population
  • Denominator
  • Numerator

Practice Fusion Suggested Workflow

Practice Fusion suggests the following workflow to help ensure that you are able to meet the requirements of this measure within the Practice Fusion EHR.

  1. Ensure that patients with diabetes have an appropriate diagnosis, with a start date, recorded in the medical record. Examples of diabetes diagnosis codes that can be used for this measure can be found in Table 1.
  2. Receive or record structured lab results for HbA1c tests in the Practice Fusion EHR. HbA1c Test codes that will be included in this measure when manually recording structured lab results in the Practice Fusion EHR or when receiving structured lab results from connected labs can be found in Table 1.

Table 1: Examples of Coded Values that can be recorded for CMS 122v5

Data Type

Example Codes

Diabetes Diagnosis Codes*

  • 250.00-250.03 (ICD-9)
  • 250.11-250.13 (ICD-9)
  • E10.10 (ICD-10)
  • E10.11 (ICD-10)
  • E10.22 (ICD-10)
  • E10.311(ICD-10)

HbA1c Test Codes

  • Hemoglobin A1c/ in Blood by HPLC (LOINC code 17856-6)
  • Hemoglobin A1c/ in Blood (LOINC code 4548-4)
  • Hemoglobin A1c/ in Blood by Electrophoresis (LOINC code 4549-2)

*Note: Only patients with a diagnosis of Type 1 or Type 2 diabetes will be included in the denominator of this measure; patients with a diagnosis of secondary diabetes due to another condition will not be included. To access a complete list of appropriate diagnosis codes, visit the United States Health Information Knowledgebase (USHIK). This site is produced by the Agency for Healthcare Research and Quality (AHRQ) in partnership with CMS and the National Library of Medicine (NLM). A free Unified Medical Language System® (UMLS) license, available from NLM, is required to access USHIK.

Additional Measure Information

  • This 2016 measure version has been updated from the previous 2015 version specifications, incorporating the following changes:

    • Clarification added that when the HbA1c test result is in the medical record, it can be used to determine numerator compliance.

    • Measure name updated to cohere with the endorsed measure name.

  • A patient is numerator compliant if his or her most recent HbA1c level is >9%, the most recent HbA1c result is missing, or if there are no HbA1c tests performed and results documented during the measurement period.

  • This measure uses structured lab results to determine whether a patient factors into the numerator. If your lab company is connected to Practice Fusion and sending the appropriate structured lab results electronically, your numerator will calculate automatically. Please note that this is an inverse measure, meaning that a lower numerator score indicates better performance: as patients in the denominator receive lab results with HbA1c levels <9.0%, the numerator will decrease. The lower the numerator, the more patients you have seen with controlled HbA1c levels.

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