HEDIS Measures and Technical Resources

Prevention and Screening

• Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (WCC)
• Childhood Immunization Status (CIS)
• Immunizations for Adolescents (IMA)
• Lead Screening in Children (LSC)
• Breast Cancer Screening (BCS)
• Cervical Cancer Screening (CCS)
• Colorectal Cancer Screening (COL)
• Chlamydia Screening in Women (CHL)
• Care for Older Adults (COA)

Respiratory Conditions

• Appropriate Testing for Pharyngitis (CWP)
• Use of Spirometry Testing in the Assessment and Diagnosis of COPD (SPR)
• Pharmacotherapy Management of COPD Exacerbation (PCE)
• Asthma Medication Ratio (AMR)

Cardiovascular Conditions

• Controlling High Blood Pressure (CBP)
• Persistence of Beta-Blocker Treatment After a Heart Attack (PBH)
• Statin Therapy for Patients With Cardiovascular Disease and Diabetes (SPC, SPD)
• Cardiac Rehabilitation (CRE)

Diabetes

• Comprehensive Diabetes Care (CDC)
• Kidney Health Evaluation for Patients With Diabetes (KED)

Musculoskeletal Conditions

• Osteoporosis Testing and Management in Older Women (OMW)

Behavioral Health

• Antidepressant Medication Management (AMM)
• Follow-Up Care for Children Prescribed ADHD Medication (ADD)
• Follow-Up After Hospitalization for Mental Illness (FUH)
• Follow-Up After Emergency Department Visit for Mental Illness (FUM)
• Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence (FUA)
• Diabetes and Cardiovascular Disease Screening and Monitoring for People With Schizophrenia or Bipolar Disorder (SSD, SMD, SMC)
• Adherence to Antipsychotic Medications for Individuals With Schizophrenia (SAA)
• Metabolic Monitoring for Children and Adolescents on Antipsychotics (APM)
• Pharmacotherapy for Opioid Use Disorder (POD)
• Follow-Up After High-Intensity Care for Substance Use Disorder (FUI)

Medication Management and Care Coordination

• Transitions of Care (TRC)
• Follow-Up After Emergency Department Visit for People With Multiple High-Risk Chronic Conditions (FMC)

Overuse/Appropriateness

• Non-Recommended Cervical Cancer Screening in Adolescent Females (NCS)
• Non-Recommended PSA-Based Screening in Older Men (PSA)
• Appropriate Treatment for Upper Respiratory Infection (URI)
• Avoidance of Antibiotic Treatment for Acute Bronchitis/Bronchiolitis (AAB)
• Use of Imaging Studies for Low Back Pain (LBP)
• Medication Management in Older Adults (DDE, DAE)
• Use of Opioids at High Dosage (HDO)
• Use of Opioids from Multiple Providers (UOP)
• Risk of Continued Opioid Use (COU)

Measures Collected Through the Medicare Health Outcomes Survey

• Fall Risk Management (FRM)
• Management of Urinary Incontinence in Older Adults (MUI)
• Physical Activity in Older Adults (PAO)

Measures Collected Through the CAHPS^® Health Plan Survey

• Flu Vaccinations (FVA, FVO)
• Medical Assistance with Smoking and Tobacco Use Cessation (MSC)
• Pneumococcal Vaccination Status for Older Adults (PNU)

• Adults’ Access to Preventive/Ambulatory Health Services (AAP)
• Annual Dental Visit (ADV)
• Initiation and Engagement of Alcohol and Other Drug Abuse or Dependence Treatment (IET)
• Prenatal and Postpartum Care (PPC)
• Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics (APP)

• Child and Adolescent Well-Care Visits (W30, WCV)
• Frequency of Selected Procedures (FSP)
• Identification of Alcohol and Other Drug Services (IAD)
• Mental Health Utilization (MPT)
• Antibiotic Utilization for Respiratory Conditions (AXR)

• Plan All-Cause Readmissions (PCR)
• Hospitalization Following Discharge From a Skilled Nursing Facility (HFS)
• Acute Hospital Utilization (AHU)
• Emergency Department Utilization (EDU)
• Hospitalization for Potentially Preventable Complications (HPC)

• Breast Cancer Screening (BCS-E)
• Colorectal Cancer Screening (COL-E)
• Follow-Up Care for Children Prescribed ADHD Medication (ADD-E)
• Depression Screening and Follow-Up for Adolescents and Adults (DSF-E)
• Utilization of the PHQ-9 to Monitor Depression Symptoms for Adolescents and Adults (EMS-E)
• Depression Remission or Response for Adolescents and Adults (DRR-E)
• Unhealthy Alcohol Use Screening and Follow-Up (ASF-E)
• Adult Immunization Status (AIS-E)
• Prenatal Immunization Status (PRS-E)
• Prenatal Depression Screening and Follow-up (PND-E)
• Postpartum Depression Screening and Follow-up (PDS-E)

Vol. 1: Narrative

Overview of the HEDIS measurement set and how the data are used.

• Order this publication
• HEDIS MY 2024 Summary of Changes
• HEDIS MY 2024 Measure Descriptions (Updated December 4, 2023)
• HEDIS MY 2024 Technical Release Notes (Posted October 27, 2023)

Vol. 2: Technical Specifications for Health Plans

HEDIS nonsurvey measures for organizations; instructions on data collection for each measure; general guidelines for calculations and sampling.

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• Technical Specifications Update (Anticipated Release Date: April 1, 2024)
• HEDIS MY 2024 Audit Timeline (Anticipated Release Date: April 1, 2024)
• HEDIS MY 2024 Risk Adjustment Tables (Anticipated Release Date: April 1, 2024)
  Note: The Risk Adjustment Tables is available for free order in the NCQA Store. Once ordered, the Risk Adjustment Tables is made available in the “My Downloads” tab on My NCQA.”
• HEDIS MY 2024 Medication List Directory (NDC codes) (Anticipated Release Date: April 1, 2024)
  Note: The Medication List Directory is available for free order in the NCQA Store. Once ordered, the Medication List Directory is made available in the “My Downloads” tab on My NCQA.”
• HEDIS MY 2024 Public Reporting Memo (Anticipated Release Date: October 1, 2024)
• HEDIS MY 2024 Measure Trending Determinations (Anticipated Release Date: Summer 2024)
• HEDIS Electronic Clinical Data System (ECDS)
• HEDIS FAQs

HEDIS Measures Included in the Quality Rating System (QRS)

Quality Rating System Measure Technical Specifications are unique to the issuers offering plans on the Exchange and participating in the CMS Quality Rating System (QRS).

• MY 2024 HEDIS for the Quality Rating System Value Set Directory (Anticipated Release Date: April 1, 2024)
• HEDIS for the Quality Rating System Technical Specifications
• MY 2024 Quality Rating System: Technical Update (Anticipated Release Date: April 1, 2024)
• HEDIS for the Quality Rating System FAQs

Vol. 3: Specifications for Survey Measures

HEDIS survey measures and standardized surveys from the Consumer Assessment of Healthcare Providers and Systems (CAHPS^®) program.

• Order this publication (Anticipated Release Date: September 2024)
• CAHPS 5.1H Survey 
• Survey Vendor Certification Program
• MY 2024 Validated Member-Level File Layout (Anticipated Release Date: January 2025)

Vol. 5: HEDIS Compliance Audit™: Standards, Policies and Procedures

The approved method for auditing the HEDIS production process, including an information systems capabilities assessment, an evaluation of compliance with HEDIS specifications and standards that Certified HEDIS Compliance Auditors must use when conducting a HEDIS audit.

• Order this publication (Anticipated Release Date: August 2024)
• HEDIS Compliance Audit
• Specification Updates (Anticipated Release Date: December 2024)

Vol. 6: The Medicare Health Outcomes Survey Manual

Technical specifications for the Health Outcomes Survey (HOS).

• Order this publication (Anticipated Release Date: May 2025)
• Health Outcomes Survey

HEDIS Technical Specifications for Long-Term Services and Support Measures

The technical specifications for organizations providing Medicaid long-term services and supports (LTSS).

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• Long-Term Services and Supports Programs

Vol. 1: Narrative

Overview of the HEDIS measurement set and how the data are used.

• Order this publication
• HEDIS MY 2023 Summary of Changes
• HEDIS MY 2023 Measure Descriptions

Vol. 2: Technical Specifications for Health Plans

HEDIS nonsurvey measures for organizations; instructions on data collection for each measure; general guidelines for calculations and sampling.

• Order this publication
• Order the HEDIS MY 2023 Digital Measures Bundle
• Technical Specifications Update (Updated April 5, 2023)
• HEDIS MY 2023 Audit Timeline (Posted March 31, 2023)
• HEDIS MY 2023 Risk Adjustment Tables (Posted March 31, 2023)
  Note: The Risk Adjustment Tables is available for free order in the NCQA Store. Once ordered, the Risk Adjustment Tables is made available in the “My Downloads” tab on My NCQA.”
• HEDIS MY 2023 Medication List Directory (NDC codes) (Posted March 31, 2023)
  Note: The Medication List Directory is available for free order in the NCQA Store. Once ordered, the Medication List Directory is made available in the “My Downloads” tab on My NCQA.”
• HEDIS MY 2023 Public Reporting Memo (Posted October 2, 2023)
• HEDIS MY 2023 Measure Trending Determinations (Posted May 18, 2023)
• HEDIS Electronic Clinical Data System (ECDS)
• HEDIS FAQs

HEDIS Measures Included in the Quality Rating System (QRS)

Quality Rating System Measure Technical Specifications are unique to the issuers offering plans on the Exchange and participating in the CMS Quality Rating System (QRS).

• HEDIS for the Quality Rating System Value Set Directory (Posted March 31, 2023)
• HEDIS for the Quality Rating System Technical Specifications
• Technical Specifications Update for the Quality Rating System (Updated April 12, 2023)
• HEDIS for the Quality Rating System FAQs

Technical Specifications for ACO Measurement

HEDIS quality measures for Accountable Care Organizations.

• Order this publication

Vol. 3: Specifications for Survey Measures

HEDIS survey measures and standardized surveys from the Consumer Assessment of Healthcare Providers and Systems (CAHPS^®) program.

• Order this publication (Posted May 1, 2023)
• CAHPS 5.1H Survey 
• Survey Vendor Certification Program
• MY 2023 Validated Member-Level File Layout (Anticipated Release Date: January 2024)

Vol. 5: HEDIS Compliance Audit™: Standards, Policies and Procedures

The approved method for auditing the HEDIS production process, including an information systems capabilities assessment, an evaluation of compliance with HEDIS specifications and standards that Certified HEDIS Compliance Auditors must use when conducting a HEDIS audit.

• Order this publication (anticipated release date: October 2023)
• HEDIS Compliance Audit
• Specification Updates (anticipated release date: December 2023)

Vol. 6: The Medicare Health Outcomes Survey Manual

Technical specifications for the Health Outcomes Survey (HOS).

• Order this publication (anticipated release date: May 2024)
• Health Outcomes Survey

HEDIS Technical Specifications for Long-Term Services and Support Measures

The technical specifications for organizations providing Medicaid long-term services and supports (LTSS).

• Order this publication (Anticipated Release Date: August 2022)
• Long-Term Services and Supports Programs

Vol. 1: Narrative

Overview of the HEDIS measurement set and how the data are used.

• Order this publication
• HEDIS MY 2022 Summary of Changes (Updated 7/7/2022)
• HEDIS MY 2022 Measure Descriptions

Vol. 2: Technical Specifications for Health Plans

HEDIS nonsurvey measures for organizations; instructions on data collection for each measure; general guidelines for calculations and sampling.

• Order this publication
• Order the HEDS MY 2022 Digital Measures Bundle (includes HEDIS Volume 2)
• Technical Specifications Update (Posted March 31, 2022)
• HEDIS MY 2022 Audit Timeline (Posted March 31, 2022)
• HEDIS MY 2022 Risk Adjustment Tables (Posted March 31, 2022)
  Note: The Risk Adjustment Tables are available for free order in the NCQA Store. Once ordered, the Risk Adjustment Tables will be made available in the “My Downloads” tab on My NCQA.”
• HEDIS MY 2022 Medication List Directory (NDC codes) (Posted March 31, 2022)
• Note: The Medication List Directory is available for free order in the NCQA Store. Once ordered, the Medication List Directory will be made available in the “My Downloads” tab on My NCQA.”
• HEDIS MY 2022 Public Reporting Memo (Posted October 4, 2022)
• HEDIS MY 2022 Measure Trending Determinations (Updated November 22, 2022)
• HEDIS Electronic Clinical Data System (ECDS)
• HEDIS FAQs

HEDIS Measures Included in the Quality Rating System (QRS)

Quality Rating System Measure Technical Specifications are unique to the issuers offering plans on the Exchange and participating in the CMS Quality Rating System (QRS).

• HEDIS for the Quality Rating System Value Set Directory (Posted March 31, 2022)
• HEDIS for the Quality Rating System Technical Specifications
• Technical Specifications Update for the Quality Rating System (Posted March 31, 2022)
• HEDIS for the Quality Rating System FAQs

Technical Specifications for ACO Measurement

HEDIS quality measures for Accountable Care Organizations.

• Order this publication

Vol. 3: Specifications for Survey Measures

HEDIS survey measures and standardized surveys from the Consumer Assessment of Healthcare Providers and Systems (CAHPS^®) program.

• Order this publication
• CAHPS 5.1H Survey 
• Survey Vendor Certification Program
• MY 2022 Validated Member-Level File Layout (Posted January 9, 2023)
• Technical Specifications Update (Posted November 15, 2022)

Vol. 5: HEDIS Compliance Audit™: Standards, Policies and Procedures

The approved method for auditing the HEDIS production process, including an information systems capabilities assessment, an evaluation of compliance with HEDIS specifications and standards that Certified HEDIS Compliance Auditors must use when conducting a HEDIS audit.

• Order this publication
• HEDIS Compliance Audit
• Specification Updates (Posted December 15, 2022)

Vol. 6: The Medicare Health Outcomes Survey Manual

Technical specifications for the Health Outcomes Survey (HOS).

• Order this publication (Posted: May 12, 2023)
• Health Outcomes Survey

HEDIS Technical Specifications for Long-Term Services and Support Measures

The technical specifications for organizations providing Medicaid long-term services and supports (LTSS).

• Order this publication
• Long-Term Services and Supports Programs

HEDIS Measurement Year 2021

1. HEDIS MY 2020 & MY 2021 (pdf)
2. HEDIS MY 2021 Volume 2 Technical Specifications Update (Posted March 31, 2021)
3. HEDIS MY 2021 Risk Adjustment Tables (Posted April 30, 2021)
4. HEDIS MY 2021 Medication List Directory (NDC codes)
5. HEDIS MY 2021 Public Reporting Memo (Posted October 1, 2021)
6. HEDIS MY 2021 Measure Trending Determinations
7. MY 2021 Quality Rating System Value Set Directory
8. MY 2021 Quality Rating System: Technical Update
9. MY 2021 Volume 5 Technical Specifications Update 
10. Volume 3 MY 2021 Validated Member-Level File Layout 

HEDIS Measurement Year 2020

• HEDIS MY 2020 & MY 2021 (pdf)
• HEDIS MY 2020 Volume 2 Technical Specifications Update (Posted October 1, 2020)
• HEDIS MY 2020 Risk Adjustment Tables (Posted November 2, 2020)
• NCQA HEDIS Measurement Year (MY) 2020 Requirements and COVID-19 (December 4, 2020)
• HEDIS MY 2020 Medication List Directory (NDC codes)
• HEDIS MY 2020 Measure Trending Determinations
• MY 2020 Quality Rating System Value Set Directory
• MY 2020 Quality Rating System: Technical Update
• MY 2020 Volume 3 Technical Specifications Update 
• Volume 3 MY 2020 Validated Member-Level File Layout 
• Volume 3 MY 2020 Specification Updates