New changes: Close FUA and FUM gaps using qualified billing and diagnostic codes

As of Jan. 1, 2025, the measure for follow-up after emergency department visits for mental health (FUM) will include more diagnoses, which may result in members needing follow-up appointments. Members seen in emergency department visits for substance use (FUA) also need follow-up appointments.

Medical health care providers and behavioral health care providers can use qualified billing and diagnostic codes to close the FUM and FUA HEDIS^® gaps.

How you can help

You can help close these gaps when a visit takes place within 7 days of discharge from an emergency department visit for mental health or substance use. We consider day 1 to be the day after the patient is discharged. 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 FUM and FUA HEDIS gaps

Medical and mental health care providers can use the following codes to close FUM and FUA numerator gaps in care. However, these are not intended to be a directive of your billing practice.

FUM: Behavioral health outpatient visits with any diagnosis of a mental health disorder:

98960, 98961, 98962, 99078, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99242, 99243, 99244, 99245, 99341, 99342, 99344, 99345, 99347, 99348, 99349, 99350, 99381, 99382, 99383, 99384, 99385, 99386, 99387, 99391, 99392, 99393, 99394, 99395, 99396, 99397, 99401, 99402, 99403, 99404, 99411, 99412, 99483, 99492, 99493, 99494, 99510

FUM: Outpatient visit with any diagnosis of a mental health disorder type and with appropriate place of service code:

90791, 90792, 90832, 90833, 90834, 90836, 90837, 90838, 90839, 90840, 90845, 90847, 90849, 90853, 90875, 90876, 99221, 99222, 99223, 99231, 99232, 99233, 99238, 99239, 99252, 99253, 99254, 99255

FUA: Outpatient visits with any diagnosis of substance use disorder or drug overdose OR with a mental health provider with the appropriate place of service code:

90791, 90792, 90832, 90833, 90834, 90836, 90837, 90838, 90839, 90840, 90845, 90847, 90849, 90853, 90875, 90876, 99221, 99222, 99223, 99231, 99232, 99233, 99238, 99239, 99252, 99253, 99254, 99255

FUA: Behavioral health visit with any diagnosis of substance use disorder or drug overdose OR with a mental health provider:

98960, 98961, 98962, 99078, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99242, 99243, 99244, 99245, 99341, 99342, 99344, 99345, 99347, 99348, 99349, 99350, 99381, 99382, 99383, 99384, 99385, 99386, 99387, 99391, 99392, 99393, 99394, 99395, 99396, 99397, 99401, 99402, 99403, 99404, 99411, 99412, 99483, 99492, 99493, 99494, 99510

You can find place of service and 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.