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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.
