Behavioral health and substance use measures with telehealth accommodations

Providers can impact HEDIS^® behavioral health (BH) and substance abuse measures through follow‑up care for mental illness, substance use disorders, medication adherence, and metabolic monitoring.

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

Several of the BH measures can be closed via telehealth:

• Follow‑up Care for Children Prescribed ADHD Medication (ADD)
• Follow‑up After Hospitalization for Mental Illness (FUH)
• Follow‑up After Emergency Department Visit for Mental Illness (FUM)
• Follow‑Up After Emergency Department Visit for Alcohol and Other Drugs (FUA)
• Follow‑Up After High Intensity Care for Substance Use Disorder (FUI)
• Adherence to Antipsychotic Medications for Individuals with Schizophrenia (SAA)
• Initiation and Engagement of Alcohol and Other Drug Dependence (IET)
• Antidepressant Medication Management (AMM)
• Pharmacotherapy for Opioid Use Disorder (POD)
• Depression Screening and Follow‑Up for Adolescents and Adults Depression Screening (DSF)

Providers can bill with the traditional codes that would close the gap but would need to add a telehealth code as a modifier or place of service.

POS 02 or POS 10 may be used and must be paired with the appropriate telehealth modifier (modifier 93 for audio only and modifier 95 for audio/video):

• ‑95: Synchronous telemedicine service rendered via a real‑time interactive audio and video communications system.
• Use modifier 95 when the clinician is in the hospital and the patient is in the home.
• ‑93: Synchronous telemedicine service rendered via telephone or other real‑time interactive audio‑only telecommunications system.

POS 02: Telehealth Provided Other than in Patient’s Home

Descriptor: The location where health services and health‑related services are provided or received, through telecommunication technology. Patient is not located in their home when receiving health services or health‑related services through telecommunication technology.

POS 10: Telehealth Provided in Patient’s Home

Descriptor: The location where health services and health‑related services are provided or received through telecommunication technology. Patient is in their home (which is a location other than a hospital or other facility where the patient receives care in a private residence) when receiving health services or health related services through telecommunication technology.