New changes: Close FUH gaps using qualified billing and diagnostic codes
Beginning Jan. 1, 2025, medical health care providers, in addition to behavioral health care providers, can use qualified billing and diagnostic codes to close the follow-up after hospitalization (FUH) for mental illness HEDIS® gap.
How you can help
You can help close these gaps when a visit takes place within 7 days of discharge from an inpatient setting. We consider day 1 to be the day after discharge. If a situation arises where a patient is unable to be seen within 7 days, you can schedule an appointment within 30 days of discharge.
Submit, as appropriate, qualified billing codes to help close HEDIS FUH gaps
Medical and mental health care providers can use the following codes to close FUH numerator gaps in care. However, these are not intended to be a directive of your billing practice.
| 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 |
You can find additional codes for this measure and other measures in the PATH reference guide.
If you need to refer your patient to a network behavioral health care professional for further assessment and/or additional treatment, call the behavioral health number on the back of their member ID card.
Resources
View more information and resources on our Clinical Tool page or on the Optum Provider and Staff Toolkits page.
Questions? We're here to help
Connect with us through chat 24/7 in the UnitedHealthcare Provider Portal. For additional contact information, visit our Contact us page.
1These codes are for existing patients who initiate calls to provider.
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
CPT® is a registered trademark of the American Medical Association.
PCA-1-24-03210-UHN-NN_11182024
