Well-Child Visits in the First 15 Months Tip Sheet

Incentives will be paid on an annual basis, following the end of Quarter 4. For additional information refer to the 2021 and 2022 CBI Technical Specifications.

Documentation must include a note indicating the visit was with a PCP, 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 specific age-appropriate mental developmental milestones.
• Physical exam
• Health education / anticipatory guidance: given by the PCP to parents / guardians in anticipation of emerging issues that a child and family may face

Well-visit CPT Codes: 99381, 99382, 99391, 99392, 99461

Well-visit ICD-10 Codes: Z00.110, Z00.111, Z00.121, Z00.129, Z00.2, Z76.1, Z76.2

Billing Frequency: For members 0-24 months, well-visits are payable every 14 days

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 Provider Portal.

• Run a report from your EHR system; or
• Manually compile patient data (Example: Download monthly Well-Child Visits 0-15 Months quality report or 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 originally billed under the mom’s Medi-Cal ID as well as visits that were completed during a gap in coverage from the clinic EMR/EHR system or paper records to the Alliance by the DST contractual deadline. To submit, you may upload data files to the DST on the Provider Portal. 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 Provider Portal.

• Infants and Medi-Cal – Infants are born and listed under the mother’s ID for the month of birth and the following month. Parents are encouraged to sign their infant up for Medi-Cal in a timely manner to ensure that there are no gaps in coverage for their care. There is no penalty for applying for infant’s coverage before coverage from the mother runs out.  County resources linked below:
  • Merced County
  • Monterey County
  • Santa Cruz County
• Well-visits should be scheduled at the following intervals:
  

  Birth (3 to 5 Days)	6 Months Old
  1 Month Old	9 Months Old
  2 Months Old	12 Months Old
  3 Months Old	15 Months Old
  4 Months Old

  See the American Academy of Pediatrics (AAP) Bright Futures Periodicity Schedule and guidelines for a comprehensive schedule up to 21 years of age.

• Schedule next visit before the member leaves the exam room, and provide an overview of what will be covered at the next visit.
• Ensure that all children receive developmental screenings at 9 months, 18 months, 24 or 30 months of age. If the child is at a higher risk for developmental problems may need additional screenings.
• Group well-child visits have been shown to be as effective as individual well visits. Parents had longer visits with more content, which associated with more anticipatory guidance, family-centered care, and parent satisfaction.¹
• Refer to the CDC's recommended immunization schedule and website for talking points with parents.

¹Coker, 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.