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March 2025 Top of Mind

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:

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.  

 


 

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