Well-Child Visits in the First 15 Months of Life Tip Sheet
Members age 15 months old who had 6 or more well-child visits with a PCP during the first 15 months of life.
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 provider data submissions via the Data Submission Tool on the Provider Portal, and claims.
- Run a report from your EHR system
- Manually compile patient data (Example: Download monthly breast cancer screening quality report on the Provider Portal and compare to EHR)
This measure allows providers to submit well-child visits originally billed under the mom’s Medi-Cal ID from the clinic EMR/EHR system or paper records to the Alliance at the end of the measurement year by uploading data files to the Data Submission Tool on the Provider Portal. The files are required to be submitted as a CSV file to be accepted. A Data Submission Tool Guide is available on the Provider Portal to provide you with step-by-step instructions.
Well-visit CPT Codes: 99381, 99382, 99391, 99392, 99461
Well-visit ICD-10 Codes: Z00.110, Z00.111, Z00.121, Z00.129
Billing Frequency: For members 0-24 months, well-visits are payable every 14 days
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
Infants and Medi-Cal – Infants are born and listed under the mother’s ID for the first month and will need to be prompted to sign their baby up under Medi-Cal in a timely manner to ensure that there are no gaps in coverage for their care. County resources linked below:
- 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
- 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.
© 2021 Central California Alliance for Health