Measure 117 – Diabetes: Eye Exam

Audit Criteria

When we’re reviewing your clinicians’ data, it may be helpful to know what we are looking for in order for us to verify to CMS that your data is accurate and complete. Measure 117 requires documentation that a patient with a diagnosis of diabetes received a dilated retinal eye exam with interpretation by an ophthalmologist or optometrist, or that the patient received a seven standard field stereoscopic photo exam with interpretation by an ophthalmologist or optometrist, or eye imaging was validated to match diagnosis from seven standard field stereoscopic photo results, or that the patient was at low risk for retinopathy.

  • NOTE: The eye exam must be performed or reviewed by an ophthalmologist or optometrist. Alternatively, results may be read by a qualified reading center that operates under the direction of a medical director who is a retinal specialist.

This documentation may be found in the patient’s medical record. The relevant document should be made available to the auditor for the patient requested.