New HEDIS® 2020-21* Tip Sheets

August 19, 2020


We have new tip sheets available to help you satisfy Healthcare Effectiveness Data and Information Set (HEDIS) measures and code appropriately. These measures from the National Committee for Quality Assurance (NCQA) serve as a quality improvement tool to help ensure our members receive appropriate care.

The tip sheets include measurement requirements, medical record best practices and billing codes. Compliance with HEDIS measures reduces the need for you to send medical records later for review.

Controlling High Blood Pressure (CBP) Tip Sheet
This measure assesses adults with hypertension whose blood pressure was adequately controlled:

  • 18 to 85 years old
  • Systolic blood pressure < 140 mmHg
  • Diastolic blood pressure < 90 mmHg

Childhood Immunization Status (CIS 3) Tip Sheet
This measure looks at the percentage of two-year olds who have had the appropriate vaccinations:

  • One measles, mumps and rubella (MMR)
  • One varicella zoster virus (VAR or VZV)
  • Three haemophilus influenza type B (HiB)
  • Three hepatitis B (HepB)
  • Three inactive poliovirus (IPV)
  • Four diphtheria, tetanus and acellular pertussis (DTaP)
  • Four pneumococcal conjugate (PCV)

Colorectal Cancer Screening (COL) Tip Sheet
This measure evaluates adults who had a recommended colorectal cancer screening:

  • 50 to 75 years old
  • Appropriate tests:
    • Fecal occult blood test in past year
    • Stool DNA test in past 3 years
    • Flexible sigmoidoscopy in past 5 years
    • Computed Tomography colonography in past 5 years
    • Colonoscopy in past 10 years

Use of Spirometry Testing in the Assessment and Diagnosis of COPD (SPR) Tip Sheet
This measure assesses adults with chronic obstructive pulmonary disease (COPD) who received spirometry testing to confirm the diagnosis. HEDIS requires spirometry testing to confirm the diagnosis

  • 40 years and older
  • Newly1 diagnosed with COPD, emphysema or chronic bronchitis or newly active COPD

* Measurement Year (MY) 2020 and MY 2021
1 Defined as no diagnosis of COPD, emphysema or chronic bronchitis in previous 2 years

HEDIS® is a registered trademark of the NCQA.

The above material is for informational purposes only and is not intended to be a substitute for the independent medical judgment of a physician. Physicians and other health care providers are encouraged to use their own best medical judgment based upon all available information and the condition of the patient in determining the best course of treatment.