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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



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 whose hospice care overlaps the measurement period. Exclude patients who were non-ambulatory at some point in 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
CMS139v8 139 2020 8.1.000 Not Applicable bc5b4a57-b964-4399-9d40-667c896f31ea
Steward Developer Endorsed By
American Medical Association (AMA) 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 (eg, 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 Ambulatory Status 2.16.840.1.113883.3.464.1003.118.11.1219
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 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
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


al-Aama, T. 2011. "Falls in the Elderly: Spectrum and Prevention." Can Fam Physician 57(7):771-6.
American Geriatrics Society and British Geriatric Society. (2010) Prevention of Falls in Older Persons Clinical Practice Guidelines. Accessed June 14, 2018. Available at
Centers for Disease Control and Prevention. 2015. "Important Facts about Falls" (December 14, 2015)
Doherty, 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.
Dykes, 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.
Schneider, 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.
Woolcott, 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].


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