FAQ Directory: HEDIS

Yes, changes to the Prenatal and Postpartum Care measure will be included in HEDIS MY 2027 Volume 2 (scheduled for release August 3, 2026). Consistent with the planned changes for maternity care billing, evaluation and management codes in combination with a TH modifier will meet criteria for prenatal and postpartum care. Codes no longer used for maternity care services will not be removed from the measure until the lookback period has passed. We anticipate additional codes may be added to the measure in the Technical Update release after CPT releases the full code set publication in the fall of 2026. 

HEDIS MY 2027

HbA1c results obtained from portable point-of-care devices are acceptable when the test is performed by clinical staff, regardless of whether the test is conducted at home or in a provider office. Self-collected samples are also acceptable if sent to a laboratory or provider’s office for analysis and result calculation. Self-administered tests reported by the member do not meet criteria (General Guideline: Self-Collected Samples).

HEDIS MY 2026

No. At this time, these tests are not included in the COL-E measure or its value sets and we cannot predict if or when sRNA type tests will be added.

NCQA relies on a broad body of scientific evidence and guidance from multiple independent clinical guideline bodies when developing and updating quality measures. These include, but are not limited to, recommendations from the U.S. Preventive Services Task Force (USPSTF), as well as other national organizations. NCQA monitors emerging screening concepts and reviews evidence as it becomes available through its established measure development processes.

Because of this, while some tests may receive FDA authorization and are covered under certain CMS policies, they are not automatically included in our measures. NCQA will continue to review the guidelines and scientific literature, and communicate changes if they are made.

HEDIS MY 2026

Reporting by SSoR category (e.g., EMR, HIE, case management, administrative) was sunset for MY 2026 and measure results no longer need to be attributed to an SSoR category when reported.

Additionally, HEDIS MY 2026 does not include guidance on hierarchy for ECDS reported measures. The hierarchy should not change the performance result, just the data source contributing the information.

NCQA is not prescriptive about how source prioritization is programmed into the measure logic. It is up to the plan to determine how sources are prioritized when calculating results to avoid double counting and it should be done consistently across measures.

HEDIS MY 2026

Yes, NCQA recently identified and corrected an internal administrative error related to the Osteoporosis Management in Women (OMW) measure.

As part of NCQA's routine oversight process for all measures, certain value sets related to quantitative ultrasound (QUS) were prematurely removed from the OMW measure specifications. They have since been reinstated for measurement year 2026.

The value sets are now undergoing further assessment as part of a broader examination of the Osteoporosis measure bundle, consistent with NCQA’s ongoing efforts to ensure measures are aligned with scientifically sound and methodologically credible standards of care. Any future updates to value sets will be made and communicated in accordance with established notification requirements.

NCQA regrets any confusion this may have caused.

The updated HEDIS MY 2026 Value Set Directory was made available on April 15 to all purchasers of HEDIS MY 2026 Volume 2 publication through the My Downloads section of My NCQA. The April version of the Value Set Directory must be used for HEDIS MY 2026 reporting.

HEDIS MY 2026

For buprenorphine injection dispensing events identified using a medication list, if the days supply is not available in the pharmacy data, count as a 31 days supply.

HEDIS MY 2026

Yes. There were changes to the TSC-E measure with the release of the HEDIS MY 2026 Volume 2 Technical Update on 3/31/2026. These changes to the age criteria in the measure are shown in red text in the re-released HEDIS MY 2026 Volume 2 e-pub.

The TSC-E FAQs posted on 1/15/2026 no longer apply and have been removed from the HEDIS FAQ website. The re-released HEDIS MY 2026 Volume 2 e-pub can be downloaded from the My Downloads section of My NCQA.

HEDIS MY 2026

NCQA is retaining the childhood and adolescent immunization measures in HEDIS, and as a factor in NCQA’s Health Plan Ratings.

NCQA is aware of the updates made by the CDC and HHS to the child and adolescent immunization schedule. The 2025 HEDIS measurement data has already been collected according to the HEDIS MY 2025 CIS-E and IMA-E measure specifications. As a result, NCQA is not making any changes to HEDIS MY 2025 measure reporting requirements or to Health Plan Ratings 2026 scoring based on HEDIS MY 2025 data.  

HEDIS MY 2025

Yes. Depending on the data generated for the mammography procedure, one procedure can be included as more than one episode in the initial population. The HEDIS MY 2025 measure specifications for DBM-E and FMA-E do not include steps to deduplicate mammography episodes where a procedure is represented multiple times in available data. For example, a mammography procedure can be represented in multiple claims (e.g., professional and facility claim) or within multiple data types (e.g., claim and clinical encounter). There are no steps in the measure specification to deduplicate across those data. Therefore, organizations reporting the measures can observe that a mammography procedure can be included as more than one episode in the initial population.

Organizations are allowed to deduplicate if there is a mechanism to confirm that the mammography procedures represented in the data represent the same episode. Please note that automated deduplication based on date of service is not appropriate as there may be multiple mammography procedures on the same day.  

The DBM-E and FMA-E measures are newly introduced for HEDIS MY 2025. Organizations that participate in reporting first-year measures are appreciated. Their reported results will not be public. The first-year results are used by NCQA to identify additional measure development needs and confirm the feasibility, reliability and validity of the measures prior to moving them to public reporting status. 

HEDIS MY 2026

No. C-CDA documents cannot be used for these purposes as the documents are electronically generated and not the same as the medical record documented in the primary source system where care was originally recorded (e.g. electronic medical record). This includes C-CDA documents received from HIEs.

HIEs support the exchange of clinical information, an important function for the delivery of care. Organizations are encouraged to use electronic files received from an HIE, such as electronic C-CDA or FHIR documents (e.g., C-CDA XML, FHIR JSON), as a supplemental data source.

HEDIS MY 2026

Yes. The HEDIS MY 2026 Technical Update will remove HCPCS G0136 from the measure’s screening numerators and remove ICD-10 Z codes from the measure’s intervention denominators. The measure will continue to rely on LOINC codes for documentation of standard screenings and positive screening results. Additionally, NCQA will update some intervention procedure value sets to align with current code lists.

HEDIS MY 2026

No. Each inpatient hospital stay does not need to be both acute and observation for direct transfer. When assessing for direct transfer, include those with acute inpatient to acute inpatient, observation to observation, acute inpatient to observation and observation to acute inpatient.

This applies to both MY 2026 and MY 2025

HEDIS MY 2026