Closing the Gap: HEDIS^® care measure update

To ensure patients receive appropriate mental health support, the National Committee for Quality Assurance (NCQA) updated 2 of the 2025 HEDIS^® care measures for post-discharge mental health appointments. 

Here’s what you need to know: 

• Patients should have a mental health follow-up visit within 7 days after discharge from a facility.

• Follow-up after Inpatient Hospitalization for Mental Health (FUH): The 7-day period begins the day following discharge. The day of discharge is considered “day zero.”

• Follow-up after emergency room visits for Mental Health (FUM): The 7-day period begins the day of discharge. 

What’s new

Beginning Jan. 1, 2025, follow-up care is no longer limited to a licensed mental health provider.  Both medical providers and non-licensed mental health providers can now close the gap by conducting the follow-up appointment. 

• New services and codes allowed for follow-up appointments, including:  

G0140, G0177, H0024, H0025, H0038, H0046, H2014, H2023, S9445, T1012, T1016

• Providers will need to use specific billing and diagnostic codes to have services count towards these measures*. Explore the full billing code lists below:

Follow Up after Hospitalization After Hospitalization (FUH) Billing Code List

Follow Up after Emergency Department for Mental Illness (FUM) Billing Code List

By focusing on delivering mental health services timely, rather than on the specialty of the provider delivering the service, we can all help close the care gap during a critical time for our members.  

Have questions?

You can download additional details from Provider Express.

* Payment of covered services is contingent upon multiple factors. For more information see the links above.