Child and Adolescent Well-Care Visits Tip Sheet

Incentives will be paid to the linked PCP on an annual basis, following the end of Quarter 4. For additional information, refer to the CBI Technical Specifications.

Members in hospice or using hospice services anytime during the measurement year.

Documentation must include a note indicating the visit was with a PCP or OB/GYN, and evidence of all of the following:

• Health history: assessment of the member’s history of disease or illness (allergies, medications, immunization status).
• Physical developmental history: assessment of the member’s specific age-appropriate physical developmental milestones.
• Mental developmental history: assessment of specific age-appropriate mental developmental milestones.
• Physical exam.
• Health education/anticipatory guidance: given by the PCP to the member and/or parents or guardians in anticipation of emerging issues that a child/adolescent and family may face.

Well-visit CPT Codes:

New Patients: 99382, 99383, 99384, 99385

Established Patients: 99392, 99393, 99394, 99395

Well-visit ICD-10 Codes: Z00.121, Z00.129, Z00.00, Z00.01

Additional ICD-10 Codes: Z00.2, Z00.3, Z02.5, Z01.411, Z01.419

Billing Frequency:

• 3-17 years: Well-visits payable every 180 days.
• 18-21 years: Well-visits payable once every 12 months.

Please refer to the AMA coding guidelines for billing well-care visits with office visits in the same day.  Be advised that medical records would need supportive documentation to reflect services outside of the well-care visit.

Data for this measure will be collected using claims, DHCS Fee-For-Service encounter claims, and provider data submissions via the Data Submission Tool (DST) on the Portal del Proveedor.

1. Run a report from your EHR system; or
2. Manually compile patient data (Example: Download your Care-Based Incentives Measure Details report on the Provider Portal and compare to your EHR/paper charts).

This measure allows providers to submit well-child visits from the clinic EMR/EHR system or paper records to the Alliance by the DST contractual deadline. This includes well visits that were completed before the member was eligible for Medi-Cal or during a gap in coverage. To submit, you may upload data files to the DST on the Portal del Proveedor. To be accepted, data must be submitted as a CSV file. Step-by-step instructions are available in the Data Submission Tool Guide on the Portal del Proveedor.

• The American Academy of Pediatrics (AAP) and Bright Futures recommend annual well-care visits during childhood and adolescence. See the Bright Futures Periodicity Schedule for a comprehensive schedule up to 21 years of age. Bright Futures also offers guidelines for early childhood (1-4 years), middle childhood (5-10 years) and adolescent (11-21 years) well-care visits.
• Utilize telehealth visits for patients that do not feel comfortable coming into the clinic.
• Utilize Medical Assistants to create pending orders in the EHR for each immunization due during every visit. The clinician must manually uncheck the immunization order during each visit if they are unable to provide the vaccination due for the child. This is a method of ensuring reminders for needed vaccinations are present during every visit.
• Leverage missed opportunities (episodic and sick visits) to increase preventive services (immunizations), as well as convert acute visits into well-visits (sports physicals).
• Schedule the next well-visit before the member leaves the clinic, including when they come in for a sick visit.
• Partnering with key community stakeholders like school-based clinics.
• Monitor the Portal del Proveedor reports as a tool for identifying members that are due for their well-visit.
• Create a template or use age-specific standardized templates in your EHR to maximize documentation of Bright Futures requirements and trigger reminders for the next well visits.
• Encourage teen-centered care with adolescent-friendly material and ensured confidentiality through private consultation time with the adolescent.
• Promote healthy behaviors and assess for risky behaviors to detect conditions that may interfere with physical, social and emotional development.
• Grouping child and adolescent well-care visits has been shown to be as effective as individual well-visits: Parents had longer visits with more content, which was associated with more anticipatory guidance, family-centered care and parent satisfaction.¹
• Alliance interpreting services are available to network providers:
  • Telephonic interpreting services are available to assist in scheduling members.
  • Face-to-face interpreters can be requested to be at the appointment with the member.
• Route after-hours calls from Alliance members to the Alliance’s Nurse Advice Line: 844-971-8907.
• Refer patients that have transportation challenges to the Alliance’s Transportation Coordinator at 800-700-3874 ext. 5577. This service is not covered for non-medical locations or appointments that are not medically necessary.

[1] Coker, T., Windon, A., Moreno, C., Schuster, M., Chung, P. Well-Child Care Clinical Practice Redesign for Young Children: A Systematic Review of Strategies and Tools. Pediatrics. 2013 Mar; 131(Suppl 1): S5–S25.

• Get to Know Bright Futures Guidelines and Core Tools.
• Integrate Bright Futures Into Your Electronic Health Record System.
• Practical Tips for Implementing Bright Futures in Clinical Practice from Bright Futures.
• Promoting Health for Children and Youth with Special Health Care Needs from Bright Futures.
• Integrating Social Determinants of Health into Health Supervision Visits from Bright Futures.
• Equitable Health Toolkit from Washington Chapter of the American Academy of Pediatrics.
• Academia Americana de Pediatría A Pediatrician’s Guide to an LGBTQ+ Friendly Practice