HEDIS® Tip Sheet

Follow-Up After Emergency Department Visit for Substance Use (FUA)

Measure Description

The percentage of emergency department (ED) visits for members 13 years of age and older with a principal diagnosis of substance use disorder (SUD), or any diagnosis of drug overdose, for which follow-up care was received.

Two rates are reported:

  • The percentage of ED visits where follow-up was received within 30 days of the ED visit (31 total days).
  • The percentage of ED visits where follow-up was received within 7 days of the ED visit (8 total days).
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Compliance for 7-Day and 30-Day Follow-Up

Any of the following services done with a mental health provider or having a diagnosis of substance use or drug overdose (unintentional) may count as a follow-up visit:  

  • An outpatient visit.
  • An intensive outpatient visit or partial hospitalization.
  • A non-residential substance abuse treatment facility visit.
  • A community mental health center visit.
  • An observation visit.
  • A peer support service visit.
  • An opioid treatment service that bills monthly or weekly with a diagnosis of SUD, substance use, or drug overdose.
  • A telehealth visit.
  • A telephone visit.
  • An e-visit, or virtual check-in.
  • A substance use disorder service.
  • A behavioral health screening or assessment for SUD or mental health disorders.
  • A pharmacotherapy dispensing event or medication treatment event.
  • Substance use disorder counseling and surveillance, excluding laboratory claims
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Notes

  • A member may be included in the measure more than once because the denominator is based on qualifying ED visits.
  • If the member has more than one qualifying ED visit within a 31-day period, include only the first eligible visit.
  • A follow-up may include follow-up visits and pharmacotherapy events with any diagnosis of SUD, substance use, or unintentional drug overdose.
  • Follow-up visits and pharmacotherapy events may occur on the date of the ED visit.
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Exclusions

  • ED visits that result in an inpatient stay.
  • ED visits followed by an admission to an acute or nonacute setting on the date of the ED visit or within 30 days of the ED visit regardless of the primary reason for the admission.
  • ED visits followed by residential treatment on the date of the ED visit or within 30 days after. Residential treatment includes:
    • Residential Behavioral Health Treatment Center
    • Psychiatric Residential Treatment Center
    • Residential Substance Abuse Treatment Facility
    • Residential Program Detoxification Center
  • Laboratory claims
  • Members in hospice during the measurement year.
  • Members who died during the measurement year.
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Best Practices

  • Encourage the use of telehealth appointments with a mental health provider for follow-up care.
  • Schedule follow-up visits as soon as possible and educate patients, using teach-back methods, on the importance of keeping those appointments.
  • Include caregivers, when appropriate, in discharge education and follow-up instructions.
  • Use EMR flags and reporting to identify patients who need follow-up, have canceled appointments, or did not attend scheduled visits. Contact these patients promptly to support appointment scheduling within seven days of the ED visit.
  • Consider referrals to case managers or social workers to support care coordination.
  • Use consistent diagnosis coding for alcohol or other drug abuse or dependence during subsequent follow-up visits, as only a mental illness diagnosis code will fulfill this measure.
  • Complete substance use disorder assessments during primary care visits.

Alcohol Use Disorder Treatment Medications



Opioid Use Disorder Treatment Medications



Coding and Benefits Disclaimer

Providers and organizations must submit accurate and complete data in accordance with all billing, coding, and medical policy requirements. HEDIS guidance does not override official coding standards or guarantee reimbursement, as coverage is subject to applicable medical/coding policy and member-specific benefits.

Questions

Should you have specific coding or other questions related to the measure, please send your questions to BlueAlliance@bcbsnd.com.

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Updated 8/28/2026