UHC: New Billing Code Updates to Close FUA & FUM Quality Gaps
The updated guidelines for the Follow-Up After Emergency Department Visit for Mental Illness (FUM) measure will expand the included mental health diagnosis criteria starting January 1, 2025. The expanded FUM measure will cause more patients to need clinical follow-up after emergency room treatment. Healthcare providers should schedule timely follow-up appointments for substance use disorder patients according to the FUA measure.
Medical and behavioral health providers should use qualified billing and diagnostic codes during follow-up appointments to support healthcare providers in closing HEDIS® gap measures. The follow-up appointment for patients must occur within seven days after ED discharge, where day one starts the day following their ED release. A follow-up appointment scheduled in the first 30 days after discharge will fulfill the requirements for quality measure adherence when a 7-day appointment is not possible.
Medical practitioners have access to multiple suitable billing codes, such as CPT 99202 through 99215, along with 99381–99397 and 99401–99404, and 90791–90876.
FUM: CPT codes such as 99202–99215, 99381–99397, 99401–99404, and psychiatric-specific codes like 90791–90876.
The same set of billing codes applies to FUA, but substance use disorder or overdose diagnoses should be prioritized in the diagnosis section.
Only encounters that match their assigned place-of-service codes can qualify for validity. The updates function as guidance tools to enhance quality care while avoiding any mandate for billing procedures.
The PATH reference guide and other resources assist providers in meeting requirements for HEDIS® reporting. When making network referrals, providers must reach out to the behavioral health number that appears on the member ID card of their patients.
Professional information exists on both the Clinical Tool page and the Optum Provider and Staff Toolkits. Any questions can be asked through a real-time chat service that runs 24 hours a day through the UnitedHealthcare Provider Portal.
