Certain guidelines have special cases in which a patient who meets specific criteria may be subtracted from the Eligible Population (denominator) when calculating the performance percentage. 

Denominator Exceptions vs. Denominator Exclusions

  • Denominator exclusion criteria are evaluated before checking if a patient meets the numerator criteria
    • A patient who qualifies for the denominator exclusion is always removed from the denominator
  • – Denominator exception criteria are only evaluated if the patient does not meet the numerator criteria
    • Patients who do not meet numerator criteria but do meet denominator exception criteria (e.g. medical reason for not
      performing a screening) would be removed from the denominator


Performance Rate Calculation

The performance rate is defined as:

 Performance Rate = Numerator / (Eligible Population– Exclusion – Exception)


While the number of patients in these special classes is small in most cases, there are a few guidelines that have large numbers in the exclusions and/or exceptions class.