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HEDIS® Tip Sheet

Breast Cancer Screening (BCS)

Measure Description

Percentage of Members 40-74 years of age who had a mammogram to screen for breast cancer.

Compliance:

One or more mammograms any time on or between October 1 two years prior to the measurement year and December 31 of the measurement year.

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Notes

  • MRI’s, ultrasounds, thermograms, and/or biopsies do not count toward compliance for this measure.
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Medical Records should include

  • Documentation of the date the mammogram was performed.
  • Documentation of the medical and surgical history (e.g., mastectomy) and dates performed. 
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Best Practices

  • Engage in state programs such as ScreeND.
  • Establish an annual standing order for eligible population.
  • Utilize EMR reporting and patient flags for those in need of screening.
  • Engage providers in consistent messaging.
  • Provide mammography outreach in rural areas.
  • Organize women’s health fairs.
  • Establish and promote a patient self-scheduling platform through the patient portal, enabling appointment scheduling and automated reminders.
  • Keep appointment slots open each day to allow for same-day visits.
  • Collaborate with radiology department to provide outreach to patients eligible for screening.
  • Create/participate in a Women’s Health Event which includes breast cancer screening.
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Exclusions

  • History of bilateral mastectomy on both the left and right side or both right and left unilateral mastectomies any time during the member’s history through the end of the measurement period.
  • Members who had gender-affirming chest surgery with a diagnosis of gender dysphoria anytime in the members history.
  • Members in hospice during the measurement year.
  • Members who received palliative care during the measurement year.
  • Members who died during the measurement period. 
  • Members 66+ years of age with frailty and advanced illness.
    Note: Members must meet BOTH the frailty and advanced illness criteria to be excluded:
    • At least two indicators of frailty with different dates of service during the measurement period.
    • Any of the following during the measurement year or the year prior to the measurement year:
      • At least two outpatient visits, observation visits, ED visits, telephone visits, e-visits, or virtual check-ins, nonacute inpatient encounters, or nonacute inpatient discharges on different dates of service with an advanced illness diagnosis.
      • At least on acute inpatient encounter with an advanced illness diagnosis.
      • At least one acute inpatient discharge with an advanced illness diagnosis on the discharge claim.
      • A dispensed dementia medication. 

Coding and Benefits Disclaimer

Providers and organizations must submit accurate and complete data in accordance with all billing, coding, and medical policy requirements. HEDIS guidance does not override official coding standards or guarantee reimbursement, as coverage is subject to applicable medical/coding policy and member-specific benefits.

Questions

Should you have specific coding or other questions related to the measure, please send your questions to BlueAlliance@bcbsnd.com.

NCQA Copyright Notice and Disclaimer
The HEDIS® measures and specifications were developed by and are owned by NCQA. The HEDIS measures and specifications are not clinical guidelines and do not establish a standard of medical care. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures and specifications. NCQA holds a copyright in these materials and can rescind or alter these materials at any time. These materials may not be modified by anyone other than NCQA. Use of the Rules for Allowable Adjustments of HEDIS to make permitted adjustments of the materials does not constitute a modification. Any commercial use and/or internal or external reproduction, distribution and publication must be approved by NCQA and are subject to a license at the discretion of NCQA. Any use of the materials to identify records or calculate measure results, for example, requires a custom license and may necessitate certification pursuant to NCQA’s Measure Certification Program. Reprinted with permission by NCQA. © [2025] NCQA, all rights reserved.

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).

Updated 8/28/2026