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Change to HEDIS® specification for breast cancer screening
Harvard Pilgrim Health Care·Radiology, Family Medicine, Internal Medicine +2 more·Provider Newsletter
We identified it
Jun 26, 2026
Summary
USPSTF updated breast cancer screening guidance to recommend mammography every other year for all women ages 40-74 (previously women in their 40s had discretionary screening). HEDIS has aligned their measurement specification accordingly. To meet 2025 HEDIS compliance, eligible patients must complete mammograms between October 1, 2023 and December 31, 2025.
Action Required
By December 31, 2025: Billing and clinical teams must identify and schedule all eligible female patients ages 40-74 who have not completed a mammogram since October 1, 2023 to ensure HEDIS compliance. Update patient outreach workflows and scheduling systems to reflect the expanded age range (now starting at age 40 instead of discretionary for 40-49 age group). Providers should document screening decisions in patient records consistent with USPSTF 2024 guidance. Compliance gaps will negatively impact plan quality metrics and potential reimbursement incentives tied to HEDIS performance.