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Measure: CMS146

Appropriate Testing for Children with Pharyngitis

Measure Versions

eMeasure Code Measure Year Full Version Number Title
CMS146v12 2024 12.0.000 Appropriate Testing for Pharyngitis
CMS146v11 2023 11 Appropriate Testing for Pharyngitis
CMS146v10 2022 10.1.000 Appropriate Testing for Pharyngitis
CMS146v9 2021 9.2.000 Appropriate Testing for Pharyngitis
CMS146v8 2020 8.2.000 Appropriate Testing for Children with Pharyngitis
CMS146v7 2019 7.2.000 Appropriate Testing for Children with Pharyngitis
CMS146v6 2018 6.1.000 Appropriate Testing for Children with Pharyngitis
CMS146v5 2017 5.1.000 Appropriate Testing for Children with Pharyngitis


Percentage of children 3-18 years of age who were diagnosed with pharyngitis, ordered an antibiotic and received a group A streptococcus (strep) test for the episode


This is an episode of care measure that examines all eligible episodes for the patient during the measurement period. If the patient has more than one episode, include all episodes in the measure.

Patient Group Definitions

Group Description Instructions Links
Initial PopulationChildren 3-18 years of age who had an outpatient or emergency department (ED) visit with a diagnosis of pharyngitis during the measurement period and an antibiotic ordered on or three days after the visitWebchart Instructions
DenominatorEquals Initial PopulationWebchart Instructions
Denominator ExclusionsChildren who are taking antibiotics in the 30 days prior to the diagnosis of pharyngitis. Exclude patients whose hospice care overlaps the measurement period. Exclude children who had an encounter with a competing diagnosis within three days after the initial diagnosis of pharyngitisWebchart Instructions
NumeratorChildren with a group A streptococcus test in the 7-day period from 3 days prior through 3 days after the diagnosis of pharyngitisWebchart Instructions
Numerator ExclusionsNot ApplicableWebchart Instructions
Denominator ExceptionsNone


Full eMeasure Code eMeasure Identifier Measure Year Version NQF # GUID
CMS146v8 146 2020 8.2.000 Not Applicable beb1c33c-2549-4e7f-9567-05ed38448464
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

Higher score indicates better quality


Group A streptococcal bacterial infections and other infections that cause pharyngitis (which are most often viral) often produce the same signs and symptoms (Shulman et al., 2012 ). The American Academy of Pediatrics, the Centers for Disease Control and Prevention, and the Infectious Diseases Society of America all recommend a diagnostic test for Strep A to improve diagnostic accuracy and avoid unnecessary antibiotic treatment (Linder et al ., 2005). Estimated economic costs of pediatric streptococcal pharyngitis in the United States range from $224 million to $539 million per year, including indirect costs related to parental work losses. At a higher level, the economic cost of antibiotic resistance vary but have extended as high as $20 billion in excess direct healthcare costs, with additional costs to society for lost productivity as high as $35 billion a year (2008 dollars) (Roberts et al ., 2009).

Clinical Recommendation Statement

Infectious Disease Society of America (2012) 

The Infectious Diseases Society of America  "recommends swabbing the throat and testing for GAS pharyngitis by rapid antigen detection test (RADT) and/or culture because the clinical features alone do not reliably discriminate between GAS and viral pharyngitis except when overt viral features like rhinorrhea, cough, oral ulcers, and/or hoarseness are present"



Transmission Format


Applicable Value Sets

Category Value Set OID
Diagnosis Acute Pharyngitis 2.16.840.1.113883.3.464.1003.102.12.1011
Diagnosis Acute Tonsillitis 2.16.840.1.113883.3.464.1003.102.12.1012
Diagnosis Competing Conditions for Respiratory Conditions 2.16.840.1.113883.3.464.1003.102.12.1017
Encounter, Performed Discharge Services- Observation Care 2.16.840.1.113883.3.464.1003.101.12.1039
Encounter, Performed Emergency Department Visit 2.16.840.1.113883.3.464.1003.101.12.1010
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 Hospital Observation Care - Initial 2.16.840.1.113883.3.464.1003.101.12.1002
Encounter, Performed Medical Disability Exam 2.16.840.1.113883.3.464.1003.101.11.1233
Encounter, Performed Office Visit 2.16.840.1.113883.3.464.1003.101.12.1001
Encounter, Performed Outpatient Consultation 2.16.840.1.113883.3.464.1003.101.12.1008
Encounter, Performed Preventive Care - Established Office Visit, 0 to 17 2.16.840.1.113883.3.464.1003.101.12.1024
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 - Group Counseling 2.16.840.1.113883.3.464.1003.101.12.1027
Encounter, Performed Preventive Care Services - Other 2.16.840.1.113883.3.464.1003.101.12.1030
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 Preventive Care- Initial Office Visit, 0 to 17 2.16.840.1.113883.3.464.1003.101.12.1022
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 Group A Streptococcus Test 2.16.840.1.113883.3.464.1003.198.12.1012
Medication, Active Antibiotic Medications for Pharyngitis 2.16.840.1.113883.3.464.1003.196.12.1001
Medication, Order Antibiotic Medications for Pharyngitis 2.16.840.1.113883.3.464.1003.196.12.1001
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


Linder, J. A., Bates, D. W., Lee, G. M., et al. (2005). Antibiotic treatment of children with sore throat. JAMA, 294(18), 2315-2322.
Roberts, R. R., Hota, B., Ahmad, I., et al. (2009, October). Hospital and societal costs of antimicrobial-resistant infections in a Chicago teaching hospital: Implications for antibiotic stewardship. Clinical Infectious Diseases, 49(8), 1175-1184.
Shulman , S. T., Bisno, A. L., Clegg, H. W., et al. (2012, November 15). Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. Clinical Infectious Diseases, 55(10), E86-E102. doi:10.1093/cid/cis629


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