Quality measures

HEDIS measures

68 NCQA quality measures with documentation strategies and prior authorization implications.

Measures indexed

HEDIS (Healthcare Effectiveness Data and Information Set) is the dominant quality measurement framework in US healthcare, used by >90% of health plans for NCQA accreditation, Medicare Advantage Star Ratings, Medicaid managed care quality reporting, and value-based contracting. Many measures directly affect prior authorization workflows: PA approval is often streamlined or carved out for HEDIS-aligned indications.

For clinicians, HEDIS-aligned documentation and ordering helps both your patients (faster approvals) and your panel quality scores. Browse measures by domain below.

Access/Availability of Care

ID	Measure	Age range
AAP	Adults' Access to Preventive/Ambulatory Health Services	20 and older
AMC	Adult Access to Preventive/Ambulatory Care	20-64

Behavioral Health

ID	Measure	Age range
OPF	Optimal Follow-Up for People Newly Diagnosed With Major Depressive Disorder	18 and older
RCM	Risk of Continued Opioid Use	18 and older

Care Coordination

ID	Measure	Age range
MRP	Medication Reconciliation Post-Discharge	18 and older
TEJ	Transitions of Care	Medicare

Care Coordination — Behavioral Health

ID	Measure	Age range
EBPC	Engagement of Behavioral Health Patients in Postdischarge Care	6 and older
FMC	Follow-Up After Hospitalization for Mental Illness	6 and older
FUA	Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence	13 and older
FUH	Follow-Up After Hospitalization for Mental Illness	6 and older
FUM	Follow-Up After Emergency Department Visit for Mental Illness	6 and older

Care Coordination — Geriatric

ID	Measure	Age range
ACP	Advance Care Planning	66 and older
CDF	Care for Older Adults	66 and older

Effectiveness of Care

ID	Measure	Age range
MPM	Annual Monitoring for Patients on Persistent Medications	18 and older

Effectiveness of Care — Behavioral Health

ID	Measure	Age range
AMM	Antidepressant Medication Management	18 and older
APM	Metabolic Monitoring for Children and Adolescents on Antipsychotics	1-17
ASF	Unhealthy Alcohol Use Screening and Follow-Up	18 and older
CCP	Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics	1-17
COU	Risk of Continued Opioid Use	18 and older
DSE	Diabetes Screening for People With Schizophrenia or Bipolar Disorder Using Antipsychotic Medications	18-64
NAA	Pharmacotherapy for Opioid Use Disorder	18 and older
PHQ	Depression Screening and Follow-Up for Adolescents and Adults	12 and older
SAA	Adherence to Antipsychotic Medications for Individuals With Schizophrenia	18-64

Effectiveness of Care — Behavioral Health & Wellness

ID	Measure	Age range
CHL	Chlamydia Screening in Women	16-24 (women)

Effectiveness of Care — Cancer

ID	Measure	Age range
BCS	Breast Cancer Screening	50-74 (women)
CCS	Cervical Cancer Screening	21-64 (women)
COL	Colorectal Cancer Screening	45-75
PSA	Non-Recommended PSA-Based Screening in Older Men	70 and older (men)

Effectiveness of Care — Cardiovascular

ID	Measure	Age range
ASE	Aspirin Use and Discussion	45-79 (men); 55-79 (women)
CBP	Controlling High Blood Pressure (same as CTR)	18-85
CTR	Controlling High Blood Pressure	18-85
SPC	Statin Therapy for Patients With Cardiovascular Disease	21-75 (men); 40-75 (women)

Effectiveness of Care — Diabetes

ID	Measure	Age range
BPD	Blood Pressure Control for Patients With Diabetes	18-75
CDC	Comprehensive Diabetes Care (multi-rate)	18-75
KCA	Kidney Health Evaluation for Patients With Diabetes	18-85
SPD	Statin Therapy for Patients With Diabetes	40-75

Effectiveness of Care — Geriatric

ID	Measure	Age range
PAD	Use of High-Risk Medications in the Elderly	65 and older

Effectiveness of Care — Musculoskeletal

ID	Measure	Age range
ART	Disease-Modifying Anti-Rheumatic Drug Therapy for Rheumatoid Arthritis	18 and older
DMS	Use of Imaging Studies for Low Back Pain	18-50
OMS	Osteoporosis Management in Women Who Had a Fracture	67-85 (women)

Effectiveness of Care — Pediatric

ID	Measure	Age range
AIS	Adolescent Immunization Status	13
CIS	Childhood Immunization Status (Combo 10)	2
IMM	Immunizations for Adolescents	13
LSC	Lead Screening in Children	2
W15	Well-Child Visits in the First 15 Months of Life	0-15 months
W30	Well-Child Visits in the First 30 Months of Life	0-30 months
WCC	Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents	3-17
WCV	Child and Adolescent Well-Care Visits	3-21

Effectiveness of Care — Preventive

ID	Measure	Age range
FPM	Flu Vaccinations for Adults Ages 18-64 and 65+	18 and older
FVA	Flu Vaccinations for Adults Ages 65+	65 and older
TSC	Tobacco Use Screening and Cessation Intervention	18 and older

Effectiveness of Care — Respiratory

ID	Measure	Age range
AAB	Avoidance of Antibiotic Treatment for Acute Bronchitis/Bronchiolitis	3 months and older
ABX	Avoidance of Antibiotic Treatment in Adults With Acute Bronchitis	18-64
ADT	Asthma Medication Ratio (AMR — also called ADT)	5-64
AMP	Use of Spirometry Testing in the Assessment and Diagnosis of COPD	40 and older
AMR	Asthma Medication Ratio (replacement for ADT)	5-64
CWP	Appropriate Testing for Pharyngitis	3 and older
PCE	Pharmacotherapy Management of COPD Exacerbation	40 and older

Effectiveness of Care — Women's Health

ID	Measure	Age range
OSW	Osteoporosis Screening in Older Women	65-85 (women)
PCC	Prenatal Care Access — First Trimester	All pregnant
PPC	Prenatal and Postpartum Care	Women who delivered
PPV	Postpartum Care Visit Timeliness	Postpartum members

Medication Adherence

ID	Measure	Age range
PDC	Proportion of Days Covered — multiple drug classes	18 and older

Risk Adjustment

ID	Measure	Age range
RDM	Risk Adjustment Documentation and Coding	Medicare Advantage members

Use of Services

ID	Measure	Age range
AMB	Ambulatory Care: Outpatient & ED Visits	All
PCR	Plan All-Cause Readmissions	18 and older

Use of Services — Opioid Safety

ID	Measure	Age range
PDO	Use of Opioids From Multiple Providers	18 and older
UOP	Use of Opioids at High Dosage	18 and older

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