FAQ Directory: HEDIS

No, because new LOINC codes were released after publication of MY 2026, organizations can use supplemental data to meet the numerator requirements. The documentation must meet the requirements outlined in General Guideline: Supplemental Data. NCQA does not approve code mapping, and the auditor will determine whether the data meet the intent of the measure.

New codes for self-collected specimens were included in LOINC’s recent release and additional pre-release codes are currently published on the LOINC website (and will be included in the next LOINC release).  NCQA will review and include appropriate codes in the MY 2027 Technical Update release scheduled for March 31, 2027.

**This FAQ applies to HEDIS Volume 2 MY 2026 & MY 2027.  

HEDIS MY 2027

The final NCQA-supported version of these retired measures are the HEDIS MY 2026 Volume 2 Technical Update version of the measure specifications. Any subsequent change to a measure specification is an independently modified version and is not maintained, reviewed or endorsed by NCQA. 

HEDIS MY 2027

NCQA will not maintain the measures post-retirement. Organizations that choose to use a retired measure are responsible for determining whether and how to use, adapt, update or interpret it. NCQA assumes no responsibility for the continued availability, accuracy, maintenance or licensing of retired measure value sets.

HEDIS MY 2027

The measures approved for HEDIS MY 2027 retirement were:

• Documented Assessment After Mammogram (DBM-E)
• Oral Evaluation, Dental Services (OED)
• Topical Fluoride for Children (TFC)
• Diagnosed Mental Health Disorders (DMH)
• Diagnosed Substance Use Disorders (DSU)
• Diabetes Monitoring for People With Diabetes and Schizophrenia (SMD)
• Cardiovascular Monitoring for People With Cardiovascular Disease and Schizophrenia (SMC)
• Use of Opioids at High Dosage (HDO)
• Risk of Continued Opioid Use (COU)
• Language Description of Membership (LDM)

HEDIS MY 2027

The CCS-E measure allows at-home, self-collected HPV vaginal samples that are sent to a laboratory or provider's office for analysis (see General Guideline: Self-Collected Samples). Organizations can identify qualifying screenings through multiple approved data sources, including claims, laboratory data, electronic clinical data and medical records. The absence of a specific code does not exclude identification of a qualifying screening if the organization can demonstrate numerator compliance using an approved data source that meets the requirements of the measure.

When using supplemental data (e.g., laboratory data, electronic clinical data or medical record documentation) to assess the numerator (i.e., the provider did not bill one of the codes in the measure), the documentation must meet the requirements outlined in General Guideline: Supplemental Data. NCQA does not approve code mapping, and the auditor will determine whether the data meet the intent of the measure.

If a laboratory bills for the test using any of the CPT codes in the High Risk HPV Lab Test Value Set then this meets numerator criteria. The CPT codes are not specific to sample type (vaginal versus cervical) therefore billing is based on the specific assay and types being detected by the laboratory.

**This FAQ applies to HEDIS Volume 2 MY 2026 & MY 2027. 

HEDIS MY 2027

The retired measures will be removed in the HEDIS MY 2027 Technical Specification Update release on March 31, 2027.

HEDIS MY 2027

No. Traditional HEDIS reporting remains supported. The updated structure introduces terminology and structure that align with FHIR-based digital measures, but it does not require organizations to adopt Digital HEDIS or change their current reporting approach. Organizations may continue using their existing reporting methods while gaining visibility into how those specifications align with future digital quality measurement models.

HEDIS MY 2028

NCQA is finalizing the subset of measures that will be released in the updated format for MY 2028. Additional information will be provided before publication of the HEDIS MY 2028 Volume 2 specifications.

HEDIS MY 2028

The updated specification structure is intended to organize and align information with its FHIR-based digital equivalent and is not intended to change current reporting expectations. Organizations should continue following existing HEDIS reporting guidance and audit requirements.

If questions arise regarding a specific measure or implementation scenario, NCQA welcomes questions or comments through My NCQA, utilizing the MY 2028 Preview: Measure Specification Enhancements option within the 'General Content Area' dropdown under the HEDIS option within the 'Product/Program Type' dropdown.

HEDIS MY 2028

No. Organizations can continue using their current systems, reporting processes, workflows and operational practices. The updates do not introduce new reporting requirements or require changes to existing implementations. The updated structure is designed to help organizations that choose to pursue digital quality measurement in the future, while preserving current reporting expectations.

HEDIS MY 2028

The specification structure updates do not change:
•    Measure intent.
•    Calculation logic.
•    Reporting requirements.
•    Data element reporting requirements.
•    Audit expectations.
•    Existing workflows and operational processes.
•    Performance rates or trending assumptions.

Organizations can continue using the same codes, data sources, timing guidance, workflows and audit practices they rely on today.

HEDIS MY 2028

Organizations may notice:
•    More detailed descriptions of data sources.
•    Terminology aligned with the FHIR® data model.
•    Timing and status language that aligns with FHIR®-based digital measures.
•    A connection between narrative specifications and digital measure specifications.

The updated structure is intended to help organizations understand how existing narrative specifications align with their digital equivalents. It is not intended to change reporting requirements for current HEDIS submissions.

HEDIS MY 2028