Child and Adolescent Well-Care Visits Tip Sheet
The percentage of enrolled members 3–21 years of age who had at least one comprehensive well-care visit with a PCP or an OB/GYN practitioner during the measurement year.
Incentives will be paid to the linked PCP on an annual basis, following the end of quarter 4. For additional information refer to the 2021 CBI Technical Specifications.
Data for this measure will be collected using claims.
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
- 3-17 years: Well-visits payable every 180 days
- 18-21 years: Well-visits payable once every 12 months
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 the member and/or parents or guardians in anticipation of emerging issues that a child/adolescent and family may face.
- 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, as well as their resource kit and guidelines for early (1-4 years) and middle childhood (5-10 years), and adolescent (11-21 years) well-care visits.
- Leverage Missed Opportunities (episodic and sick visits) to increase preventive services (immunizations), as well as convert visits into well visits (sports physicals).
- Partnering with key community stakeholders like school-based clinics.
- Monitor the Provider Portal reports as a tool for identifying members that are due for their well-visit.
- Create a template with a checklist for child and adolescent well-care visits to ensure measure compliance.
- 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.
- Group child and adolescent well-care 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
- Route after hours calls for Alliance members to the Alliance’s Nurse Advice Line: 1 (844) 971-8907.
- Refer patients that have transportation challenges to the Alliance’s Transportation Coordinator at 1-800-700-3874 ext. 5577; this service is not covered for non-medical locations or appointments that are not medically necessary.