Child and Adolescent Well-Care Visits Tip Sheet

Incentives are paid to the linked primary care provider (PCP) on an annual basis, following the end of quarter four. For additional information, refer to the CBI Technical Specifications.

Note: ICD-10 Z codes that indicate well-visits do not count if they are on a claim with a lab place of service code 81 for CBI 2025.

• Administrative members at the end of the measurement period.
• Dual coverage members.
• Members in hospice, receiving hospice services or palliative care, who had an encounter for palliative care or who died during the measurement year.

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

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:

• Three to 17 years of age: Well-visits are payable every 180 days.
  • Well-visits are not required every 180 days.
• Eighteen to 21 years: Well-visits are payable once every 12 months.

Please refer to the American Medical Association (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 is collected using claims, DHCS Fee-For-Service encounter claims, and provider data submissions via the Data Submission Tool (DST) on the Provider Portal. To find gaps in data:

1. Run a report from your Electronic Health Record (EHR) system; or
2. Manually compile patient data. For example, download your monthly Child and Adolescent Well-Care Visit report on the Provider Portal and compare it to your EHR/paper records.

This measure allows providers to submit well-child visits from the clinic 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, 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.

• 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.
• Use 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 to ensure 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.
• Partner with key community stakeholders such as school-based clinics.
• Monitor the Monthly Quality Reports on the Provider Portal as a tool to identify members who 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 ensure 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. This is 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]
• Route after-hours calls from Alliance members to the Alliance Nurse Advice Line:
  844-971-8907.

[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.

• Alliance Cultural and Linguistic Services are available to network providers.
  • Language Assistance Services – request materials at 800-700-3874, ext. 5504.
  • Telephonic Interpreter Services – available to assist in scheduling members.
  • Face-to-Face Interpreter Services – can be requested for the appointment with
    the member.
  • For information about the Cultural and Linguistic Services Program, call the Alliance Health Education Line at 800-700-3874, ext. 5580 or email us at [email protected].
• Alliance Transportation Services for patients with transportation challenges.
  • Non-emergency medical transportation (NEMT), call 800-700-3874, ext. 5640 (TTY: Dial 711).
  • Non-medical transportation (NMT), call 800-700-3874, ext. 5577 (TTY: Dial 711).
• A Pediatrician’s Guide to an LGBTQ+ Friendly Practice – American Academy of Pediatrics.
• Equitable Health Toolkit – Washington Chapter of the American Academy of Pediatrics.
• Family-Centered and Equitable Care Approaches – American Academy of Pediatrics.
• Get to Know Bright Futures Guidelines and Core Tools – Bright Futures.
• Integrate Bright Futures Into Your Electronic Health Record System – Bright Futures.
• Integrating Social Determinants of Health into Health Supervision Visits – Bright Futures.
• Practical Tips for Implementing Bright Futures in Clinical Practice – Bright Futures.
• Promoting Health for Children and Youth with Special Health Care Needs – Bright Futures.
• Outreach Brochures: WellCare for Children and Teens – DHCS.