New Guidance for 2025 HEDIS Toolkit
Date: 07/30/25
The National Committee for Quality Assurance (NCQA) has provided new guidance as part of the HEDIS MY25 Volume 2 Technical Update that were released March 31, 2025. The following table outlines the measures that have been updated by the NCQA, and the respective Superior HealthPlan provider materials on which the original measures were originally included. For the most updated HEDIS measurements and standards, visit the NCQA website.
Measure | Document | Change |
(AMR) Asthma Medication Ratio | Remove "Albuterol budesonide" prescription from Asthma Reliever Medications grid | |
(BCS-E) Breast Cancer Screening | Change "(Females Age 50-74) to "(Members Age 40-74 )" | |
Change "Measure evaluates the percentage of members 50 to 74 years of age…” to "Measure evaluates the percentage of members 40 to 74 years of age…" | ||
(CBP) Controlling High Blood Pressure | Remove "Telephone Visits" Best Practice | |
(EED) Eye Exam for Patients with Diabetes | Add the following to Best Practice: "All eye exams must have result." | |
Add the following to Codes: "Autonomous Eye Exam: 92229" | ||
Change Description from "Automated Eye Exam" to "Autonomous Eye Exam" | ||
(KED) Kidney Health Evaluation for Patients with DM | Change "EGR" to "eGFR" | |
(SNS-E) Social Needs Screening and Intervention | For the "Children’s Health Watch Housing Stability Vital Signs™" line, change the "Positive Finding LOINC Codes >3" to "Positive Finding LOINC Codes ≤ 2" | |
(SPC) Statin Therapy for Patients with Cardiovascular Disease | Change "Lovastatin 40 mg" to "Lovastatin 40-60 mg" | |
(TRC) Transitions of Care | Change "For this measure, medication reconciliation may be conducted by a prescribing practitioner, clinical pharmacist, physician assistant, or registered nurse." to "For this measure, medication reconciliation must be conducted by a prescribing practitioner, clinical pharmacist, physician assistant, or registered nurse." |
For questions about this notice, please contact your Quality Practice Advisor.