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Measure: CMS154

Appropriate Treatment for Children with Upper Respiratory Infection (URI)

Measure Versions

eMeasure Code Measure Year Full Version Number Title
CMS154v12 2024 12.0.000 Appropriate Treatment for Upper Respiratory Infection (URI)
CMS154v11 2023 11 Appropriate Treatment for Upper Respiratory Infection (URI)
CMS154v10 2022 10.1.000 Appropriate Treatment for Upper Respiratory Infection (URI)
CMS154v9 2021 9.2.000 Appropriate Treatment for Upper Respiratory Infection (URI)
CMS154v8 2020 8.1.000 Appropriate Treatment for Children with Upper Respiratory Infection (URI)
CMS154v7 2019 7.2.000 Appropriate Treatment for Children with Upper Respiratory Infection (URI)
CMS154v6 2018 6.1.000 Appropriate Treatment for Children with Upper Respiratory Infection (URI)
CMS154v5 2017 5.1.000 Appropriate Treatment for Children with Upper Respiratory Infection (URI)


Percentage of children 3 months-18 years of age who were diagnosed with upper respiratory infection (URI) and were not dispensed an antibiotic prescription on or three days after 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 age 3 months to 18 years who had an outpatient visit with a diagnosis of URI during the measurement periodWebchart Instructions
DenominatorEquals Initial PopulationWebchart Instructions
Denominator ExclusionsExclude children who are taking antibiotics in the 30 days prior to the encounter during which the diagnosis was established. Exclude children who had an encounter with a competing diagnosis within three days after the initial diagnosis of URI. Exclude patients whose hospice care overlaps the measurement period.Webchart Instructions
NumeratorChildren without a prescription for antibiotic medication on or 3 days after the outpatient or ED visit for an upper respiratory infectionWebchart Instructions
Numerator ExclusionsNot ApplicableWebchart Instructions
Denominator ExceptionsNone


Full eMeasure Code eMeasure Identifier Measure Year Version NQF # GUID
CMS154v8 154 2020 8.1.000 Not Applicable e455fac0-f2cb-4074-a351-1e68a90fb7cf
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 scores indicates better quality


Most URI, also known as the common cold, are caused by viruses that require no antibiotic treatment. Too often, antibiotics are prescribed inappropriately, which can lead to antibiotic resistance (when antibiotics can no longer cure bacterial infections). In the United States, at least 2 million antibiotic-resistant illnesses and 23,000 deaths occur each year, at a cost to the U.S. economy of at least $30 billion.

Clinical Recommendation Statement

American Family Physician (Fashner, Ericson, and Werner, Khilberg 2012) 

- Antibiotics should not be used for the treatment of cold symptoms in children or adults. (A) 

- Nonsteroidal anti-inflammatory drugs reduce pain secondary to upper respiratory tract infection in adults. (A) 

- Decongestants, antihistamine/decongestant combinations, and intranasal ipratropium (Atrovent) may improve cold symptoms in adults. (B)



Transmission Format


Applicable Value Sets

Category Value Set OID
Diagnosis Competing Conditions for Respiratory Conditions 2.16.840.1.113883.3.464.1003.102.12.1017
Diagnosis Upper Respiratory Infection 2.16.840.1.113883.3.464.1003.102.12.1022
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 Hospital Observation Care - Initial 2.16.840.1.113883.3.464.1003.101.12.1002
Encounter, Performed Office Visit 2.16.840.1.113883.3.464.1003.101.12.1001
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- 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
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


Centers for Disease Control and Prevention. (2013). "Be antibiotics aware: Smart use, best care." retrieved from
Fashner, J., Ericson, K., & Werner, S. (2012). Treatment of the common cold in children and adults. American Family Physician, 86(2), 153-159.
Harris, A.M., Hicks, L.A., Qaseem, A. (2016.) "Appropriate antibiotic use for acute respiratory tract infection in adults: advice for high-value care from the American College of Physicians and The Centers for Disease Control and Prevention." Ann Intern Med. 164(6):425-434.
Hersh, A. L.,  Shapiro, D. J., Pavia, A. T., et al. (2011). "Antibiotic prescribing in ambulatory pediatrics in the United States." Pediatrics 128(6), :1053-1061.


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CPT(R) contained in the Measure specifications is copyright 2004-2018 American Medical Association. LOINC(R) copyright 2004-2018 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2018 International Health Terminology Standards Development Organisation. ICD-10 copyright 2018 World Health Organization. All Rights Reserved