Diabetic Eye Exams: 2025 Reference Guide for Documentation and Claim Coding

Woman receiving an eye exam

As an eye care provider, you play a key role in the early detection and timely treatment of diabetes-related eye diseases such as retinopathy (CDC).  To ensure patients with evidence of retinopathy have an eye exam annually, NCQA® created the Eye Exam for Patients with Diabetes (EED) measure of the Healthcare Effectiveness Data and Information Set (HEDIS®).  This measure assesses the percentage of patients aged 18-75 with a diagnosis of diabetes (type 1 and type 2) who had a retinal eye exam. This tip sheet (available here) provides key details of the EED HEDIS® measure.

*HEDIS®, which stands for Healthcare Effectiveness Data and Information Set, is a registered trademark of the National Committee for Quality Assurance, or NCQA. Measure specifications are from the National Committee for Quality Assurance.

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