Screenings
For the Breast Cancer Screening (BCS) measure, this is the specific age range of women who must have a mammogram to be compliant.
Ages 40-74
To satisfy the Kidney Health Evaluation for Patients with Diabetes (KED) measure, these two specific lab tests must be performed annually.
hat are eGFR (estimated Glomerular Filtration Rate) and uACR (urine Albumin-Creatinine Ratio)?
The Care for Older Adults (COA) measure (Functional Assessment and Med Review) applies specifically to members of this age as of December 31 of the measurement year.
What is 66 years and older?
For the Diabetic Retinal Eye Exam (EED), if a member had a negative retinal exam (no retinopathy) in the year prior, how often do they need a repeat exam?
What is every two years (biennially)?
Across almost all these measures (BCS, COL, KED, etc.), members are excluded if they are in this type of care at any point during the measurement year.
What is Hospice or Palliative Care?
As of MY 2024–2026, this common colorectal cancer screening (COL) method is compliant for one year, but only if it is a "fecal occult" type.
What is a gFOBT (guaiac-based fecal occult blood test)? (FIT is also acceptable annually).
In MY 2026, the SPC-E (Statin Therapy for Patients with Cardiovascular Disease) measure updated the age range for the female population to match the male range. This is the new age range for both.
What is 21–75 years of age?
To meet the Medication Review indicator, the review must be performed by a prescribing practitioner or this specific type of clinical professional.
What is a Clinical Pharmacist?
Note: A registered nurse can collect the list of current medications from the member during the call, but there must be evidence that the appropriate practitioner reviewed the list.
This specific eye care professional must perform or read the results of the retinal eye exam for it to be NCQA compliant.
What is an Optometrist or Ophthalmologist?
For COL, if a member has a history of this surgical procedure, they are permanently excluded from the measure.
What is a total colectomy or colorectal cancer?
In the Depression Screening and Follow-Up measure (DSF-E), this specific instrument was newly added as an approved screening tool for adults 18+ for MY 2026.
What is the PROMIS® Emotional Distress instrument?
For the KED measure, if the urine albumin and urine creatinine tests are not performed as a combined uACR, they must be performed within this many days of each other.
What is 4 days or less?
Note: A quantitative urine albumin test AND a urine creatinine test (billed for service dates 4 days or less apart.
A Functional Status Assessment must include notation of at least one of these two major categories of daily life activities.
What are ADLs (Activities of Daily Living) or IADLs (Instrumental Activities of Daily Living)?
Note: IADLs vs. ADLs
While ADLs (Activities of Daily Living) are basic self-care tasks like bathing and eating, IADLs are more complex and are often the first to be affected when an individual needs support or has cognitive decline.
For MY 2026, the KED measure excludes members age 66 and older who are enrolled in this specific type of Medicare plan.
What is an Institutional Special Needs Plan (I-SNP)?
For the COA measures, services rendered during these two types of non-physical visits now meet the criteria for compliance.
What are Telehealth (Telephone/Video) or E-visits?
For Colorectal Cancer Screening (COL), a colonoscopy performed during the measurement year or this many years prior meets the numerator criteria.
What is 9 years prior (totaling a 10-year window)?
What is moderate or high intensity?
For a Functional Status Assessment to be compliant, it must assess at least five ADLs or at least this many IADLs.
What is four?
In the SUPD measure, this is the age range for members with diabetes who are required to be on a statin.
What is 40–75 years old?
This exclusion was removed from the BCS measure for the 2026 measurement year.
What is the combination of unilateral mastectomy with a bilateral modifier?
For BCS, this is the look-back period (in months) for a bilateral mammogram to satisfy the measure.
What is 27 months?
This is one of the exclusions that applies only to the SPC measure, but not the SUPD measure.
What is Myalgia?
Can a COA Functional Status Assessment be conducted in an inpatient setting to meet measurement criteria?
What are the 2 types of exams that suffice for closure of the DEE measure.
What are Dilated or retinal eye exam or Fundus photography?
For the SUPD measure in 2026, members who do not meet numerator compliance or have additional exception criteria and have at least 1 prescription claim during the measurement period using their Part D benefits for any of these meds will be taken out of the denominator.
What are Repatha, Praluent, or bempedoic acid (Nexletol)?