diff --git a/src/main/java/gov/cms/madie/services/MeasureMapper.java b/src/main/java/gov/cms/madie/services/MeasureMapper.java
index 319edcb..86b00d0 100644
--- a/src/main/java/gov/cms/madie/services/MeasureMapper.java
+++ b/src/main/java/gov/cms/madie/services/MeasureMapper.java
@@ -90,7 +90,7 @@ public interface MeasureMapper {
   @Mapping(target = "aggregation", source = "rateAggregation")
   @Mapping(target = "rationale", source = "measure.measureMetaData.rationale")
   @Mapping(target = "recommendations", source = "measure.measureMetaData.clinicalRecommendation")
-  @Mapping(target = "improvementNotations", source = "measure.improvementNotation")
+  @Mapping(target = "improvementNotations", expression = "java(getImprovementNotations(measure))")
   @Mapping(target = "references", source = "measure.measureMetaData.references")
   @Mapping(target = "definitions", source = "measure.measureMetaData.definition")
   @Mapping(target = "guidance", source = "measure.measureMetaData.guidance")
@@ -143,6 +143,13 @@ public interface MeasureMapper {
   @Mapping(target = "uuid", source = "measureSetId")
   QualityMeasureSetType measureToQualityMeasureSet(QdmMeasure measure);
 
+  default String getImprovementNotations(QdmMeasure measure) {
+    if ("Other".equals(measure.getImprovementNotation())) {
+      return measure.getImprovementNotationOther();
+    }
+    return measure.getImprovementNotation();
+  }
+
   // measureGrouping mappings
   default MeasureGroupingType measureToMeasureGroupingType(
       QdmMeasure measure, CqlLookups cqlLookups) {
diff --git a/src/test/java/gov/cms/madie/services/MeasureMapperTest.java b/src/test/java/gov/cms/madie/services/MeasureMapperTest.java
index 4e8142b..cbb5d05 100644
--- a/src/test/java/gov/cms/madie/services/MeasureMapperTest.java
+++ b/src/test/java/gov/cms/madie/services/MeasureMapperTest.java
@@ -1022,4 +1022,23 @@ void testCqlDefinitionsToFunctionsType() {
     assertThat(argumentTypes.get(0).getQdmDataType(), is(equalTo(arg1.getQdmDataType())));
     assertThat(argumentTypes.get(0).getArgumentName(), is(equalTo(arg1.getArgumentName())));
   }
+
+  @Test
+  void testGetImprovementNotationsForOther() {
+    String customNotation = "Custom improvement notation";
+    QdmMeasure measure =
+        QdmMeasure.builder()
+            .improvementNotation("Other")
+            .improvementNotationOther(customNotation)
+            .build();
+    assertThat(measureMapper.getImprovementNotations(measure), is(equalTo(customNotation)));
+  }
+
+  @Test
+  void testGetImprovementNotationsForIncreaseScore() {
+    String notation = "Increased score indicates improvement";
+    QdmMeasure measure =
+        QdmMeasure.builder().improvementNotation(notation).improvementNotationOther("").build();
+    assertThat(measureMapper.getImprovementNotations(measure), is(equalTo(notation)));
+  }
 }