Quality ManagementMedicaidApril 1, 2025

HEDIS® tip sheet

This HEDIS® tip sheet will provide you with information on Emergency Department visits for mental illness and the associated CPT® and ICD‑10-CM codes.

Follow‑Up After ED visit for Mental Illness (FUM) measure description

The measure focuses on follow‑up visits with any practitioner for mental illness after an ED visit with a principal diagnosis of mental illness or intentional self‑harm in members six years and older.

Two rates are reported for follow‑up visits after an ED visit:

  • Within seven days of the ED visit (eight total days)
  • Within 30 days of the ED visit (31 total days)

If the first follow‑up visit is within seven days after discharge, then both rates are counted for this measure.

The best practice to meet the compliance code is to qualify mental health diagnosis as the principal diagnosis.

Note: The codes listed are informational only; this information does not guarantee reimbursement.

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).

Services

CPT/HCPCS

BH outpatient

CPT: 99202‑99205, 99211‑99215, 99341‑99345, 99347‑99350, 99381‑99387,

99391‑99397, 99401, 99402

HCPCS: H0004, H0031, H0036, H0040, H2010, H2011, H2014, H2015, H2019

Telehealth POS

02

Description

ICD-10-CM

Mental illness

F20.0-F20.3, F20.5, F20.81, F20.89, F20.9, F21, F22, F23, F24, F25.0, F25.1, F25.8, F25.9, F28, F29, F30.10-F30.13, F30.2-F30.4, F30.8, F30.9, F31.0, F31.10-F31.13, F31.2, F31.30-F31.32, F31.4, F31.5, F31.60-F31.64, F31.70-F31.78, F31.81, F31.89, F31.9, F32.0-F32.5, F32.81, F32.89, F32.9, F33.0-F33.3, F33.40-F33.42, F33.8, F33.9, F34.0, F34.1, F34.81, F34.89, F34.9, F39, F42.2-F42.4, F42.8, F42.9, F43.0, F43.10-F43.12, F43.20-F43.25, F43.29, F43.8, F43.9, F44.89, F53.0. F53.1, F60.0, F60.7, F60.81, F60.89, F60.9, F63.0-F63.3, F63.81, F63.89, F63.9, F68.10-F68.13, F68.8, F68.A, F84.0, F84.2, F84.3, F84.5, F84.8, F84.9, F90.0-F90.2, F90.8, F90.9, F91.0-F91.3, F91.8, F91.9, F93.0, F93.8, F93.9, F94.0-F94.2, F94.8, F94.9

Mental health diagnosis

F03.90, F03.91, F20.0-F20.3, F20.5, F20.81, F20.89, F20.9, F21-F24, F25.0, F25.1, F25.8, F25.9, F28, F29, F30.10-F30.13, F30.2-F30.4, F30.8, F30.9, F31.0, F31.10-F31.13, F31.2, F31.30-F31.32, F31.4, F31.5, F31.60-F31.64, F31.70-F31.78, F31.81, F31.89, F31.9, F32.0-F32.5, F32.81, F32.89, F32.9, F33.0-F33.3, F33.40-F33.42, F33.8, F33.9, F34.0, F34.1, F34.81, F34.89, F34.9, F39, F40.00,F40.02, F40.10, F40.11, F40.210, F40.218, F40.220, F40.228, F40.230-F40.233, F40.240,F40.243, F40.248, F40.290, F40.291, F40.298, F40.8, F40.9, F41.0, F41.1, F41.3, F41.8, F41.9, F42.2-F42.4, F42.8, F42.9, F43.0, F43.10-F43.12, F43.20-F43.25, F43.29, F43.8, F43.9, F44.0-F44.2, F44.4-F44.7, F44.81, F44.89, F44.9, F45.0, F45.1, F45.20-F45.22, F45.29, F45.41, F45.42, F45.8, F45.9, F48.1, F48.2, F48.8, F48.9, F50.00-F50.02, F50.2, F50.82, F50.89, F50.9, F51.01-F51.05, F51.09, F51.11-F51.13, F51.19, F51.3-F51.5, F51.8, F51.9, F52.0, F52.1, F52.21, F52.22, F52.31, F52.32, F52.4, F52.5, F52.6, F52.8, F52.9, F53.0, F53.1, F59, F60.0-F60.7, F60.81, F60.89, F60.9, F63.0-F63.3, F63.81, F63.89, F63.9, F64.0-F64.2, F64.8, F64.9, F65.0-F65.4, F65.5.0,F65.52, F65.81, F65.89, F65.9, F66, F68.10-F68.13, F68.8, F69, F80.0-F80.2, F80.4, F80.81, F80.82, F80.89, F80.9, F81.0, F81.2, F81.81, F81.89, F81.9, F82, F84.0, F84.2, F84.3, F84.5, F84.8, F84.9, F88, F89, F90.0, F90.1, F90.2, F90.8, F90.9, F91.0-F91.3, F91.8, F91.9, F93.0, F93.8, F93.9, F94.0-F94.2, F94.8, F94.9, F95.0-F95.2, F95.8, F95.9, F98.0, F98.1, F98.21, F98.29, F98.3-F98.5, F98.8, F98.9, F99

Coverage provided by Wellpoint West Virginia, Inc.

WVWP-CD-077644-25

PUBLICATIONS: April 2025 Provider Newsletter