HEDIS Quality Measure Toolkit
What is HEDIS®?
- HEDIS stands for Healthcare Effectiveness Data and Information Set.
- Developed by the National Committee for Quality Assurance (NCQA) in the 1980s.
- NCQA Specifications standardize performance to evaluate and compare health plan performance and quality.
- Contains 6 domains of care which are further divided into measures/sub-measures which include preventative care and condition specific care.
- Required for ongoing NCQA Health Plan accreditation.
How is HEDIS data collected?
Depending on the measure, data may be collected through:
- Administrative/claims data
- Supplemental files sent in by the provider during the year
- Medical record reviews
- Survey Method
- Electronic Clinical Data Systems (ECDS)
Measure specifications outline measure description, exclusions and how the data may be collected.
View the General Guidelines and Measure Descriptions for best practice and measure tips.
HEDIS Measures
| Measure Name | Health Plan/Program | Eligibility |
|---|---|---|
| Acute Hospitalizations Following Outpatient Colonoscopy (HFC) |
Advantage MD |
Persons 65 years of age and older |
| Acute Hospitalizations Following Outpatient General Surgery (HFG) | Advantage MD | Persons 65 years of age and older |
| Acute Hospitalizations Following Outpatient Orthopedic Surgery (HFO) |
Advantage MD |
Persons 65 years of age and older |
| Acute Hospitalizations Following Outpatient Urologic Surgery (HFU) |
Advantage MD |
Persons 65 years of age and older |
| Adherence to Antipsychotic Medications for Individuals With Schizophrenia (SAA) |
Advantage MD, EHP, Priority Partners, USFHP |
Persons 18 years of age and older |
| Adults’ Access to Preventative / Ambulatory Health Services (AAP) | Advantage MD, EHP, Priority Partners, USFHP | Persons 20 years of age and older |
| Adult Immunization Status (AIS-E) |
Advantage MD, EHP, Priority Partners, USFHP |
Persons 19 years of age and older |
| Advance Care Planning (ACP) | Advantage MD, Dual Eligible Special Needs Plans (D-SNP) | Persons 66 years of age and older |
| Appropriate Testing for Pharyngitis (CWP) | Advantage MD, EHP, Priority Partners, USFHP | Persons 3 years of age and older |
| Appropriate Treatment for Upper Respiratory Infection (URI) | Advantage MD, EHP, Priority Partners, USFHP |
Persons 3 months old and older |
| Avoidance of Antibiotic Treatment for Acute Bronchitis/Bronchiolitis (AAB) | Advantage MD, EHP, Priority Partners, USFHP | Persons 3 months old and older |
| Blood Pressure Control for Patients With Diabetes (BPD/BPD-E) | Advantage MD, EHP, Priority Partners/PHIP, USFHP | Persons 18–75 years of age |
| Blood Pressure Control for Patients With Hypertension (BPC-E) |
Advantage MD, EHP, Priority Partners, USFHP |
Persons 18–75 years of age |
| Breast Cancer Screening (BCS-E) | Advantage MD, EHP, Priority Partners, USFHP | Women 50–74 years of age |
| Cardiac Rehabilitation (CRE) |
Advantage MD, EHP, Priority Partners, USFHP |
Persons 18 years of age and older |
| Cardiovascular Monitoring for People With Cardiovascular Disease and Schizophrenia (SMC) |
Priority Partners |
Persons 18–64 years of age |
| Care for Older Adults (COA) | Advantage MD, D-SNP | Persons 66 years of age and older |
| Cervical Cancer Screening (CCS-E) | EHP, Priority Partners, USFHP | Women 21–64 years of age |
| Child and Adolescent Well-Care Visits (WCV) | EHP, Priority Partners, USFHP | Persons 3–21 years of age |
| Childhood Immunizations (CIS-E) | EHP, Priority Partners, USFHP | Children turning 2 years old |
| Chlamydia Screening (CHL) | EHP, Priority Partners, USFHP | Women 16-24 years of age |
| Colorectal Cancer Screening (COL-E) | Advantage MD, D-SNP, EHP, Priority Partners, USFHP | Persons 45–75 years of age |
| Controlling High BP (CBP) | Advantage MD, D-SNP, EHP, Priority Partners, USFHP | Persons 18–85 years of age |
| Depression Remission or Response for Adolescents and Adults (DRR-E) |
Advantage MD, EHP, Priority Partners, USFHP |
Persons 12 years of age and older |
| Depression Screening and Follow-Up for Adolescents and Adults (DSF-E) |
Advantage MD, EHP, Priority Partners, USFHP |
Persons 12 years of age and older |
| Diabetes Monitoring for People With Diabetes and Schizophrenia (SMD) |
Priority Partners |
Persons 18–64 years of age |
| Diabetes Screening for People With Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medications (SSD) |
Priority Partners |
Persons 18–64 years of age |
| Diagnosed Mental Health Disorders (DMH) |
Advantage MD, EHP, Priority Partners, USFHP |
Persons 1 year of age and older |
| Diagnosed Substance Use Disorders (DSU) |
Advantage MD, EHP, Priority Partners, USFHP |
Persons 13 years of age and older |
| Documented Assessment After Mammogram (DBM-E) |
Advantage MD, EHP, Priority Partners, USFHP |
Persons 40-74 years of age |
| Eye Exam for Patients With Diabetes (EED) | Advantage MD, EHP, Priority Partners, USFHP | Persons 18–75 years of age |
| Follow-Up After Abnormal Mammogram Assessment (FMA-E) |
Advantage MD, EHP, Priority Partners, USFHP |
Persons 40-74 years of age |
| Follow-Up After Acute and Urgent Care Visits for Asthma (AAF-E) | EHP, Priority Partners, USFHP |
Persons 5-64 years of age |
| Follow-Up After Emergency Department Visit for Mental Illness (FUM) |
Advantage MD, EHP, Priority Partners, USFHP |
Persons 6 years of age and older |
| Follow-up After Emergency Department Visit for People with Multiple High-Risk Chronic Conditions (FMC) |
Advantage MD |
Persons 18 years of age and older |
| Follow-Up After Emergency Department Visit for Substance Use (FUA) |
Advantage MD, EHP, Priority Partners, USFHP |
Persons 13 years of age and older |
| Follow-Up After High-Intensity Care for Substance Use Disorder (FUI) |
Advantage MD, EHP, Priority Partners, and USFHP |
Persons 13 years of age and older |
| Follow-Up After Hospitalization for Mental Illness (FUH) |
Advantage MD, D-SNP, EHP, Priority Partners, USFHP |
Persons 6 years of age and older |
| Follow-Up Care for Children Prescribed ADHD Medication (ADD-E) | EHP, Priority Partners, USFHP | Persons 6–12 years of age |
| Glycemic Status Assessment for Patients With Diabetes (GSD) | Advantage MD, EHP, Priority Partners/PHIP, USFHP | Persons 18–75 years of age |
| Immunizations for Adolescents (IMA-E) | EHP, Priority Partners, USFHP | Persons 13 years of age |
| Kidney Health Evaluation for Patients With Diabetes (KED) | Advantage MD, EHP, Priority Partners, USFHP | Persons 18–75 years of age |
| Lead Screening in Children-HEDIS (LSC-E) | Priority Partners/PHIP | Persons 0–2 years of age |
| Medication Adherence for Cholesterol (Statins) (MAC) | Advantage MD | Persons 18 years of age or older |
| Medication Adherence for Diabetes Medications (MAD) | Advantage MD | Persons 18 years of age or older |
| Medication Adherence for Hypertension (RAS antagonists) (MAH) | Advantage MD | Persons 18 years of age or older |
| Metabolic Monitoring for Children and Adolescents on Antipsychotics (APM-E) | EHP, Priority Partners, USFHP | Persons 1–17 years of age |
| Non-Recommended PSA-Based Screening in Older Men (PSA) |
Advantage MD |
Men 70 years and older |
| Osteoporosis Management in Women Who Had a Fracture (OMW) | Advantage MD, D-SNP | Women 67–85 years of age |
| Osteoporosis Screening in Older Women (OSW) | Advantage MD | Women 65–75 years of age |
| Persistence of Beta-Blocker Treatment After a Heart Attack (PBH) |
Advantage MD, EHP, Priority Partners, USFHP |
Persons 18 years of age and older |
| Pharmacotherapy for Opioid Use Disorder (POD) |
Advantage MD, EHP, Priority Partners, USFHP |
Persons 16 years of age and older |
| Pharmacotherapy Management of COPD Exacerbation (PCE) | Advantage MD, D-SNP, EHP, Priority Partners, USFHP | Persons 40 years of age and older |
| Plan All-Cause Readmission (PCR) | Advantage MD, D-SNP, EHP, Priority Partners, USFHP | Persons 18 years of age and older |
| Postpartum Depression Screening and Follow-Up (PDS-E) |
EHP, Priority Partners, USFHP |
Women who had a live birth(s) on or between 9/8 year prior to the measurement period and 9/7 of the measurement period |
| Prenatal and Postpartum Care (PPC) | EHP, Priority Partners/PHIP, USFHP | Women who had a live birth(s) on or between 10/8 year prior to the measurement period and 10/7 of the measurement period |
| Prenatal Depression Screening and Follow-Up (PND-E) |
EHP, Priority Partners, USFHP |
Women who had a live birth(s) during the measurement period |
| Prenatal Immunization Status (PRS-E) | EHP, Priority Partners, USFHP | Women who deliver at >37 weeks during the measurement period |
| Risk of Continued Opioid Use (COU) | Advantage MD, EHP, Priority Partners/PHIP, USFHP | Persons 18 years of age or older |
| Social Need Screening and Intervention (SNS-E) |
Advantage MD, EHP, Priority Partners, USFHP |
Persons 18 years of age or older |
| Statin Therapy for Patients with Cardiovascular Disease (SPC-E) | Advantage MD, EHP, Priority Partners, USFHP | Persons 21–75 years of age |
| Statin Therapy for Patients With Diabetes (SPD-E) | Advantage MD, EHP, Priority Partners, USFHP | Persons 40–75 years of age |
| Statin Use in Persons With Diabetes (SUPD) | Advantage MD | Persons with diabetes 40–75 years of age |
| Tobacco Use Screening and Cessation Intervention (TSC-E) | Advantage MD, EHP, Priority Partners, USFHP |
Persons 12 years of age and older |
| Topical Fluoride for Children (TFC) | Priority Partners |
Persons 1-4 years of age |
| Transitions of Care (TRC) | Advantage MD, D-SNP | Persons 18 years of age and older |
| Unhealthy Alcohol Use Screening and Follow-Up (ASF-E) |
Advantage MD, EHP, Priority Partners, USFHP |
Persons 18 years of age or older |
| Use of First Line Psychosocial Care for Children and Adolescents on Antipsychotics (APP) | EHP, Priority Partners, USFHP | Persons 1 - 17 years of age |
| Use of Imaging Studies for Low Back Pain (LBP) | Advantage MD, EHP, Priority Partners, and USFHP | Persons 18 – 75 years of age |
| Use of Opioids at High Dosage (HDO) |
Advantage MD, EHP, Priority Partners, and USFHP |
Persons 18 years of age and older |
| Use of Opioids from Multiple Providers (UOP) |
Advantage MD, EHP, Priority Partners, and USFHP |
Persons 18 years of age and older |
| Utilization of the PHQ-9 to Monitor Depression Symptoms for Adolescents and Adults (DMS-E) |
Advantage MD, EHP, Priority Partners, USFHP |
Persons 12 years of age or older |
| Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (WCC) | EHP, Priority Partners, USFHP | Persons 3–17 years of age |
| Well-Child Visits in the First 30 Months of Life (W30) | EHP, Priority Partners, USFHP | Persons 15–30 months of age |
Please contact your Provider Engagement Liaison or email [email protected] with any questions.
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HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA). The HEDIS measures and specifications were developed by and are owned by NCQA. NCQA holds a copyright in these materials and may rescind or alter these materials at any time. Users of the HEDIS measures and specifications shall not have the right to alter, enhance or otherwise modify the HEDIS measures and specifications, and shall not disassemble, recompile or reverse engineer the HEDIS measures and specifications. Anyone desiring to use or reproduce the materials, subject to licensed user restrictions, without modification for an internal non-commercial purpose may do so without obtaining any approval from NCQA. Use of the Rules for Allowable Adjustments of HEDIS to make permitted adjustments of the materials does not constitute a modification. All other uses, including a commercial use (including but not limited to vendors using the measures and specifications with a product or service to calculate measure results), or any external reproduction, distribution and publication of the HEDIS measures or results (“rates”) therefrom must be approved by NCQA and are subject to a license at the discretion of NCQA. Any use of the materials to identify records or calculate measure results, for example, requires a custom license and may necessitate certification pursuant to NCQA’s Measure Certification Program.
HEDIS measures and specifications are not clinical guidelines, do not establish a standard of medical care and have not been tested for all potential applications. The measures and specifications are provided “as is” without warranty of any kind. NCQA makes no representations, warranties or endorsements about the quality of any product, test or protocol identified as numerator compliant or otherwise identified as meeting the requirements of a HEDIS measure or specification. NCQA also makes no representations, warranties or endorsements about the quality of any organization or clinician who uses or reports performance measures. NCQA has no liability to anyone who relies on HEDIS measures and specifications or data reflective of performance under such measures and specifications.
Limited proprietary coding is contained in the measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. NCQA disclaims all liability for use or accuracy of any third-party code values contained in the specifications.
This HEDIS® Value Set Directory (HEDIS VSD) was developed by and is owned by the National Committee for Quality Assurance (NCQA). NCQA holds a copyright in the HEDIS VSD and may rescind or alter the HEDIS VSD at any time. Users shall not have the right to alter, enhance or otherwise modify the HEDIS VSD, and shall not disassemble, recompile or reverse engineer the HEDIS VSD. Anyone desiring to use or reproduce the HEDIS VSD without modification for an internal non-commercial purpose may do so without obtaining approval from NCQA. All other uses, including a commercial use and/or external reproduction, distribution or publication must be approved by NCQA and are subject to a license at the discretion of NCQA. The HEDIS VSD is provided “as is” without warranty of any kind.
The HEDIS VSD contains proprietary code values owned by third parties that are protected under federal copyright laws. All uses of the third-party codes may require a license from the copyright owner. NCQA disclaims all liability for use of the third-party codes.
© 2025 by the National Committee for Quality Assurance, all rights reserved.
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