Streamline FUH Gap Closure with Updated Billing and Diagnostic Code Requirements

Beginning January 1, 2025, medical and behavioral health care providers will be able to use qualified
billing and diagnostic codes to address the follow-up after hospitalization (FUH) for mental illness
HEDIS® gap.

How they can help:

Providers can help to close these gaps if the visit occurs within 7 days of discharge from an inpatient
setting. Postoperative day one is defined as the day after the patient is discharged from the hospital. If a
patient cannot be seen within 7 days, then an appointment can be arranged within 30 days after
discharge.

Submission of appropriate billing codes to close HEDIS FUH gaps: Medical and mental health care
providers are encouraged to use specific codes to address FUH numerator gaps in care. However, these
codes should not be viewed as directives for billing practices.

Behavioral health outpatient visits with a mental health care provider OR with a diagnosis of
mental health disorder

98960–98962, 99078, 99202–99205, 99211–99215, 99242–99245, 99341, 99342, 99344, 99345,
99347–99350, 99381–99387, 99391–99397, 99401–99404, 99411, 99412, 99483, 99492–99494
and 99510

Outpatient visit, in person or telehealth, with a mental health care provider OR with a diagnosis of
mental health disorder, and with the appropriate service code (visit setting unspecified) billing codes

90791, 90792, 90832–90834, 90836–90840, 90845, 90847, 90849, 90853, 90875, 90876, 99221–99223,
99231–99233, 99238, 99239 and 99252–99255

Psychiatric collaborative care management billing codes

99492, 99493, 99494; HCPCS: G0512

Transitional care management billing codes

99495, 99496

Telephone visits billing codes1

98966–98968, 99441–99443

Additional codes for this measure and others can be located in the PATH reference guide.

If there is a need to refer a patient to a network behavioral health care professional for further
assessment and/or treatment, please contact the behavioral health number listed on the back of the
patient’s member ID card.

Resources: For more information and resources, please visit the Clinical Tool page or the Optum
Provider and Staff Toolkits page.

 


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