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Measure: CMS122

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

Measure Versions

eMeasure Code Measure Year Full Version Number Title
CMS122v12 2024 12.0.000 Diabetes: Hemoglobin A1c (HbA1c) Poor Control (> 9%)
CMS122v11 2023 11 Diabetes: Hemoglobin A1c (HbA1c) Poor Control (> 9%)
CMS122v10 2022 10.0.000 Diabetes: Hemoglobin A1c (HbA1c) Poor Control (> 9%)
CMS122v9 2021 9.3.000 Diabetes: Hemoglobin A1c (HbA1c) Poor Control (> 9%)
CMS122v8 2020 8.4.000 Diabetes: Hemoglobin A1c (HbA1c) Poor Control (> 9%)
CMS122v7 2019 7.4.000 Diabetes: Hemoglobin A1c (HbA1c) Poor Control (> 9%)
CMS122v6 2018 6.1.000 Diabetes: Hemoglobin A1c (HbA1c) Poor Control (> 9%)
CMS122v5 2017 5.0.000 Diabetes: Hemoglobin A1c (HbA1c) Poor Control (> 9%)


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


Patient is numerator compliant if most recent HbA1c level >9%, the most recent HbA1c result is missing, or if there are no HbA1c tests performed and results documented during the measurement period. If the HbA1c test result is in the medical record, the test can be used to determine numerator compliance. Only patients with a diagnosis of Type 1 or Type 2 diabetes should be included in the denominator of this measure; patients with a diagnosis of secondary diabetes due to another condition should not be included. This eCQM is a patient-based measure. This version of the eCQM uses QDM version 5.5. Please refer to the eCQI resource center ( for more information on the QDM.

Patient Group Definitions

Group Description Instructions Links
Initial PopulationPatients 18-75 years of age with diabetes with a visit during the measurement periodWebchart Instructions
DenominatorEquals Initial PopulationWebchart Instructions
Denominator ExclusionsExclude patients whose hospice care overlaps the measurement period. Exclude patients 66 and older who are living long term in an institution for more than 90 consecutive days during the measurement period. Exclude patients 66 and older with advanced illness and frailty because it is unlikely that patients will benefit from the services being measured.Webchart Instructions
NumeratorPatients whose most recent HbA1c level (performed during the measurement period) is >9.0%Webchart Instructions
Numerator ExclusionsNot ApplicableWebchart Instructions
Denominator ExceptionsNone


Full eMeasure Code eMeasure Identifier Measure Year Version NQF # GUID
CMS122v9 2021 9.3.000 Not Applicable f2986519-5a4e-4149-a8f2-af0a1dc7f6bc
Steward Developer Endorsed By
National Committee for Quality Assurance National Committee for Quality Assurance
Scoring Method Measure Type Stratification Risk Adjustment
Proportion Intermediate Outcome None None

Rate Aggregation


Improvement Notation

Lower score indicates better quality


As the seventh leading cause of death in the U.S., diabetes kills approximately 79,500 people a year and affects more than 30 million Americans (9.4 percent of the U.S. population) (Centers for Disease Control and Prevention [CDC], 2017a, 2017b). Diabetes is a long-lasting disease marked by high blood glucose levels, resulting from the body's inability to produce or use insulin properly (CDC, 2019). People with diabetes are at increased risk of serious health complications including vision loss, heart disease, stroke, kidney failure, amputation of toes, feet or legs, and premature death (CDC, 2016). In 2017, diabetes cost the U.S. an estimated $327 billion: $237 billion in direct medical costs and $90 billion in reduced productivity. This is a 34 percent increase from the estimated $245 billion spent on diabetes in 2012 (American Diabetes Association, 2018). Controlling A1c blood levels help reduce the risk of microvascular complications (eye, kidney and nerve diseases) (CDC, 2014).

Clinical Recommendation Statement

American Diabetes Association (2019):

- A reasonable A1C goal for many nonpregnant adults is <7%. (Level of evidence: A)

- Providers might reasonably suggest more stringent A1C goals (such as <6.5% [48 mmol/mol]) for selected individual patients if this can be achieved without significant hypoglycemia or other adverse effects of treatment (i.e. polypharmacy). Appropriate patients might include those with short duration of diabetes, type 2 diabetes treated with lifestyle or metformin only, long life expectancy, or no significant cardiovascular disease (CVD). (Level of evidence: C)

- Less stringent A1C goals (such as <8% [64 mmol/mol]) may be appropriate for patients with a history of severe hypoglycemia, limited life expectancy, advanced microvascular or macrovascular complications, extensive comorbid
 conditions, or long-standing diabetes in whom the goal is difficult to achieve despite diabetes self-management education, appropriate glucose monitoring, and effective doses of multiple glucose-lowering agents including insulin. (Level of evidence: B)



Transmission Format


Applicable Value Sets

Category Value Set OID
Diagnosis Diabetes 2.16.840.1.113883.3.464.1003.103.12.1001
Diagnosis Frailty Diagnosis 2.16.840.1.113883.3.464.1003.113.12.1074
Encounter, Performed Acute Inpatient 2.16.840.1.113883.3.464.1003.101.12.1083
Encounter, Performed Annual Wellness Visit 2.16.840.1.113883.3.526.3.1240
Encounter, Performed Care Services in Long-Term Residential Facility 2.16.840.1.113883.3.464.1003.101.12.1014
Encounter, Performed ED 2.16.840.1.113883.3.464.1003.101.12.1085
Encounter, Performed Encounter Inpatient 2.16.840.1.113883.3.666.5.307
Encounter, Performed Frailty Encounter 2.16.840.1.113883.3.464.1003.101.12.1088
Encounter, Performed Home Healthcare Services 2.16.840.1.113883.3.464.1003.101.12.1016
Encounter, Performed Nonacute Inpatient 2.16.840.1.113883.3.464.1003.101.12.1084
Encounter, Performed Nursing Facility Visit 2.16.840.1.113883.3.464.1003.101.12.1012
Encounter, Performed Observation 2.16.840.1.113883.3.464.1003.101.12.1086
Encounter, Performed Office Visit 2.16.840.1.113883.3.464.1003.101.12.1001
Encounter, Performed Outpatient 2.16.840.1.113883.3.464.1003.101.12.1087
Encounter, Performed Preventive Care Services - Established Office Visit, 18 and Up 2.16.840.1.113883.3.464.1003.101.12.1025
Encounter, Performed Preventive Care Services-Initial Office Visit, 18 and Up 2.16.840.1.113883.3.464.1003.101.12.1023
Intervention, Order Hospice care ambulatory 2.16.840.1.113762.1.4.1108.15
Intervention, Performed Hospice care ambulatory 2.16.840.1.113762.1.4.1108.15
Laboratory Test, Performed HbA1c Laboratory Test 2.16.840.1.113883.3.464.1003.198.12.1013
Medication, Active Dementia Medications 2.16.840.1.113883.3.464.1003.196.12.1510
Patient Characteristic Ethnicity Ethnicity 2.16.840.1.114222.4.11.837
Patient Characteristic Payer Payer 2.16.840.1.114222.4.11.3591
Patient Characteristic Race Race 2.16.840.1.114222.4.11.836
Patient Characteristic Sex ONC Administrative Sex 2.16.840.1.113762.1.4.1
Symptom Frailty Symptom 2.16.840.1.113883.3.464.1003.113.12.1075


American Diabetes Association. (2018). Economic costs of diabetes in the U.S. in 2017. Diabetes Care, 41, 917-928. Retrieved from
American Diabetes Association. (2019). 6. Glycemic targets: Standards of medical care in diabetes—2019. Diabetes Care, 42(Suppl. 1), S61-S70.
Centers for Disease Control and Prevention. (2014). National diabetes statistics report, 2014. Atlanta, GA: U.S. Department of Health and Human Services, CDC. Retrieved from
Centers for Disease Control and Prevention. (2016). At a glance 2016: Diabetes—Working to reverse the U.S. epidemic. Atlanta, GA: Author. Retrieved from
Centers for Disease Control and Prevention. (2017a). Health, United States, 2016: With chartbook on long-term trends in health. Retrieved from
Centers for Disease Control and Prevention. (2017b). National diabetes statistics report, 2017. Atlanta, GA: U.S. Department of Health and Human Services, CDC. Retrieved from
Centers for Disease Control and Prevention. (2019). About diabetes. Retrieved from


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