HEDIS MY25 Specs: A Deep Dive
- The National Commitee for Quality Assurance (NCQA) has finalized its updates to the Healthcare Effectiveness Data and Information Set (HEDIS®) measures for Measurement Year 2025.
- Several existing HEDIS measures have been retired or modified.
- NCQA has removed all ICD-9 codes from measure value sets and transitioned the Eye Exam for Patients with Diabetes (EED) measure to administrative-only reporting.This significantly reduces hybrid reporting,...
Dive deep into the HEDIS MY25 specs with this extensive guide. The National Committee for Quality Assurance (NCQA) has updated its Healthcare Effectiveness Data and Information Set (HEDIS) measures, emphasizing digital reporting via Electronic Clinical Data systems (ECDS) by 2030. These changes include new measures like “Blood Pressure Control” and mammography-focused metrics, alongside modifications to existing ones, all to improve health equity through data stratification. Key updates also address immunizations, mental health follow-ups, and the retirement of certain measures. News Directory 3 provides timely insights,ensuring you’re up-to-date on the evolving standards. Discover what’s next …
NCQA Updates HEDIS Measures for 2025, Prioritizing Digital Reporting and Health Equity
Updated June 14, 2025
The National Commitee for Quality Assurance (NCQA) has finalized its updates to the Healthcare Effectiveness Data and Information Set (HEDIS®) measures for Measurement Year 2025. Thes changes reflect a continued push toward fully digital measurement through Electronic Clinical Data Systems (ECDS) reporting by 2030. The updates also aim to advance health equity using race and ethnicity data stratification.
Several existing HEDIS measures have been retired or modified. The Antidepressant Medication Management (AMM) measure is fully retired. Reporting for Cervical Cancer Screening (CCS), Childhood Immunization Status (CIS), and Immunizations for adolescents (IMA) will transition to ECDS only. The Pain Assessment component of the Care for Older Adults (COA) measure is also retired.
NCQA has removed all ICD-9 codes from measure value sets and transitioned the Eye Exam for Patients with Diabetes (EED) measure to administrative-only reporting.This significantly reduces hybrid reporting, with only eight hybrid measures remaining for 2025.
Three new measures are being introduced for Measurement Year 2025. The first, Blood Pressure Control for Patients with Hypertension (BPC-E), aims to replace the hybrid measure Controlling High Blood Pressure (CBP) with an ECDS version. BPC-E reports on the percentage of members aged 18–85 with hypertension whose most recent blood pressure was less than 140/90 during the measurement period.
two new mammography-focused measures have been added to expand upon the current Breast Cancer Screening (BCS) measure. Documented Assessment After Mammogram (DBM-E) evaluates the percentage of mammogram episodes documented with a BI-RADS assessment within 14 days for members aged 40 to 74.Follow-Up After Abnormal Mammogram Assessment (FMA-E) assesses the percentage of episodes with inconclusive or high-risk BI-RADS assessments that receive appropriate follow-up within 90 days for members aged 40–74.
Existing HEDIS measures have also undergone changes.For Race and Ethnicity Stratification (RES), direct and indirect source stratifications have been removed, reducing reportable data elements by 58%. This simplifies reporting while providing insights into racial or ethnic disparities in care. The Chlamydia Screening (CHL) measure has been updated to foster more inclusive care for transgender patients, and gender stratifications have been removed from Risk measures.
Changes to Adult Immunization Status (AIS-E) include age stratification updates, updates to eligible zoster vaccines, and a new numerator for hepatitis B vaccination compliance. Updates to Follow-Up After emergency Department Visit for Mental Illness (FUM) and Follow-Up After Hospitalization for Mental Illness (FUH) include allowing intentional self-harm diagnoses in any position and adding new diagnoses to the eligibility criteria.
What’s next
Health plans should review these changes and update their data collection and reporting processes to align with the new HEDIS specifications for measurement Year 2025. This includes evaluating data sources,updating mappings,and ensuring compliance with the new requirements for digital reporting and data stratification.