Search Term or Code: Advanced Search 
Geek Mode

Measure: CMS139

Falls: Screening for Future Fall Risk

Measure Versions

eMeasure Code Measure Year Full Version Number Title
CMS139v12 2024 12.0.000 Falls: Screening for Future Fall Risk
CMS139v11 2023 11 Falls: Screening for Future Fall Risk
CMS139v10 2022 10.0.000 Falls: Screening for Future Fall Risk
CMS139v9 2021 9.2.000 Falls: Screening for Future Fall Risk
CMS139v8 2020 8.1.000 Falls: Screening for Future Fall Risk
CMS139v7 2019 7.2.000 Falls: Screening for Future Fall Risk
CMS139v6 2018 6.1.000 Falls: Screening for Future Fall Risk
CMS139v5 2017 5.0.000 Falls: Screening for Future Fall Risk


Percentage of patients 65 years of age and older who were screened for future fall risk during the measurement period


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 aged 65 years and older with a visit during the measurement periodWebchart Instructions
DenominatorEquals Initial PopulationWebchart Instructions
Denominator ExclusionsExclude patients who are in hospice care for any part of the measurement period.Webchart Instructions
NumeratorPatients who were screened for future fall risk at least once within the measurement periodWebchart Instructions
Numerator ExclusionsNot ApplicableWebchart Instructions
Denominator ExceptionsNone


Full eMeasure Code eMeasure Identifier Measure Year Version NQF # GUID
CMS139v10 139 2022 10.0.000 Not Applicable bc5b4a57-b964-4399-9d40-667c896f31ea
Steward Developer Endorsed By
National Committee for Quality Assurance National Committee for Quality Assurance
Scoring Method Measure Type Stratification Risk Adjustment
Proportion PROCESS None None

Rate Aggregation


Improvement Notation

A higher score indicates better quality


As the leading cause of both fatal and nonfatal injuries for older adults, falls are one of the most common and significant health issues facing people aged 65 years or older (Schneider, Shubert and Harmon, 2010). Moreover, the rate of falls increases with age (Dykes et al., 2010). Older adults are five times more likely to be hospitalized for fall-related injuries than any other cause-related injury. It is estimated that one in every three adults over 65 will fall each year (Centers for Disease Control and Prevention 2015). In those over age 80, the rate of falls increases to fifty percent (Doherty et al., 2009). Falls are also associated with substantial cost and resource use, approaching $30,000 per fall hospitalization Woolcott et al., 2011). Identifying at-risk patients is the most important part of management, as applying preventive measures in this vulnerable population can have a profound effect on public health (al-Aama, 2011). Family physicians have a pivotal role in screening older patients for risk of falls, and applying preventive strategies for patients at risk (al-Aama, 2011).

Clinical Recommendation Statement

All older persons who are under the care of a heath professional (or their caregivers) should be asked at least once a year about falls. (AGS/BGS/AAOS, 2010)

Older persons who present for medical attention because of a fall, report recurrent falls in the past year, or demonstrate abnormalities of gait and/or balance should have a fall evaluation performed. This evaluation should be performed by a clinician with appropriate skills and experience, which may necessitate referral to a specialist (e.g., geriatrician). (AGS/BGS/AAOS, 2010)


Screening for Future Fall Risk: Assessment of whether an individual has experienced a fall or problems with gait or balance. A specific screening tool is not required for this measure, however potential screening tools include the Morse Fall Scale and the timed Get-Up-And-Go test. Fall: A sudden, unintentional change in position causing an individual to land at a lower level, on an object, the floor, or the ground, other than as a consequence of sudden onset of paralysis, epileptic seizure, or overwhelming external force.

Transmission Format


Applicable Value Sets

Category Value Set OID
Assessment, Performed Falls Screening 2.16.840.1.113883.3.464.1003.118.12.1028
Encounter, Performed Annual Wellness Visit 2.16.840.1.113883.3.526.3.1240
Encounter, Performed Audiology Visit 2.16.840.1.113883.3.464.1003.101.12.1066
Encounter, Performed Care Services in Long-Term Residential Facility 2.16.840.1.113883.3.464.1003.101.12.1014
Encounter, Performed Discharge Services - Nursing Facility 2.16.840.1.113883.3.464.1003.101.12.1013
Encounter, Performed Encounter Inpatient 2.16.840.1.113883.3.666.5.307
Encounter, Performed Home Healthcare Services 2.16.840.1.113883.3.464.1003.101.12.1016
Encounter, Performed Nursing Facility Visit 2.16.840.1.113883.3.464.1003.101.12.1012
Encounter, Performed Office Visit 2.16.840.1.113883.3.464.1003.101.12.1001
Encounter, Performed Online Assessments 2.16.840.1.113883.3.464.1003.101.12.1089
Encounter, Performed Ophthalmological Services 2.16.840.1.113883.3.526.3.1285
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-Individual Counseling 2.16.840.1.113883.3.464.1003.101.12.1026
Encounter, Performed Preventive Care Services-Initial Office Visit, 18 and Up 2.16.840.1.113883.3.464.1003.101.12.1023
Encounter, Performed Telephone Visits 2.16.840.1.113883.3.464.1003.101.12.1080
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
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


CITATIONal-Aama, T. 2011. "Falls in the Elderly: Spectrum and Prevention." Can Fam Physician 57(7):771-6.
CITATIONAmerican Geriatrics Society and British Geriatric Society. (2010) Prevention of Falls in Older Persons Clinical Practice Guidelines. Accessed June 14, 2018. Available at
CITATIONCenters for Disease Control and Prevention. 2015. "Important Facts about Falls" (December 14, 2015)
CITATIONDoherty, M., and J. Crossen-Sills. 2009. "Fall Risk: Keep your patients in balance." The Nurse Practitioner: The American Journal of Primary Health Care 34(12):46-51.
CITATIONDykes, P.C., D.L. Carroll DL, A. Hurley A, S. Lipsitz S, A. Benoit A, F. Chang F, S. Meltzer S, R. Tsurikova R, L. Zuyov L, B. Middleton B. 2010. "Fall Prevention in Acute Care Hospitals: A Randomized Trial." JAMA . 2010;304(17):1912-1918.
CITATIONSchneider, E.C., T.E. Shubert, and K.J. Harmon. 2010. "Addressing the Escalating Public Health Issue of Falls Among Older Adults." NC  Med J 71(6):547-52.
CITATIONWoolcott, J.C., K.M. Khan, S. Mitrovic, A.H. Anis, C.A. Marra. 2011. "The Cost of Fall Related Presentations to the ED: A Prospective, In-Person, Patient-Tracking Analysis of Health Resource Utilization." Osteporos Int [Epub ahead of print].


The performance Measure is not a clinical guideline and 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].


This Physician Performance Measure (Measure) and related data specifications is owned and copyrighted by the National Committee for Quality Assurance (NCQA). NCQA makes no representations, warranties, or endorsement and NCQA has no liability to anyone who relies on or uses such measures or specifications. This Measure is not a clinical guideline and 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. All commercial uses or requests for modification must be approved by NCQA and are subject to a license at the discretion of NCQA. (C) 2020 National Committee for Quality Assurance and PCPI(R) Foundation. All Rights Reserved.

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. NCQA 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 2004-2020 American Medical Association. LOINC(R) copyright 2004-2020 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2020 International Health Terminology Standards Development Organisation. ICD-10 copyright 2020 World Health Organization. All Rights Reserved.