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HEDIS® Tip Sheet

Eye Exam for Patients with Diabetes (EED)

Measure Description

Members 18–75 years of age with diabetes (types 1 or 2) who had a retinal eye exam.

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Measure Compliance (numerator):

  • A retinal or dilated eye exam by an eye care professional (optometrist or ophthalmologist)
    • Negative retinal or dilated eye exam during the measurement year or the year before.
    • Positive retinal or dilated eye exam during the measurement year (must be done annually).

Notes:

  • This measure applies to members ages 18-75 years as of December 31st of the measurement year.
  • Includes members identified as having diabetes in the measurement year or the year prior to the measurement year.
  • Blindness is not an exclusion for a diabetic eye exam.
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Exclusions

  • Bilateral absence of eyes at any time in the member’s history.
  • Bilateral eye enucleation at any time in the member's history.
  • Members who used palliative care or had a palliative care encounter during the measurement year.
  • Members in hospice during the measurement year.
  • Member who died during the measurement year.
  • Members ages 66+ as of December 31 of the measurement year with frailty and advanced illness. Must meet both criteria:
    • Frailty: at least two frailty indicators from different dates during the measurement year.
    • Advanced Illness: either two advanced illness diagnoses on different dates (current or prior year) -or- dispensed dementia medication.
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Best Practices

  • Encourage ongoing engagement with Primary Care and assess diabetic care needs at each patient visit.
  • Ensure appropriate retinal eye exam frequency based on diagnosis: annually for patients with retinopathy and every two years for patients without retinopathy, with exams performed by a qualified eye care professional.
  • Maintain complete documentation, including date of service, exam findings, and the name and credentials of the eye care professional.
  • Educate patients and their families or caregivers about the importance of routine screenings and medication compliance.
  • Utilize reminders in the patient’s EMR to alert staff of when patients’ screenings are due.
  • Promote use of available patient portal tools (e.g., MyChart) to support patient engagement and communication.
  • Implement patient outreach strategies, including phone calls, text messages, and portal messaging, to reinforce appointment adherence.
  • Review and follow up on all diagnostic results, including laboratory testing, eye exams, and specialist referrals, to ensure continuity of care.
  • Refer patients to an optometrist or ophthalmologist for a dilated or retinal eye exam as indicated, and clearly educate patients on how this differs from a routine vision exam.

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.

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Updated 8/28/2026