Well-Child Visits in the First 15 Months 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.

• Administrative members on date of 15-month birthday.
• Dual coverage members.
• Members in hospice, receiving hospice services, or who died during the measurement year.

Documentation must include a note indicating the visit was with a PCP, 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 the member’s 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, Z02.5

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

Please refer to the American Medical Association (AMA) coding guidelines for billing well-care visits with office visits on the same day. Be advised that medical records 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:

• Run a report from your electronic health record (HER) system; or
• Manually compile patient data. For example, download the 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 records.

This measure allows providers to submit well-child visits billed under the mother’s Medi-Cal ID, as well as visits that were completed during a gap in coverage, from the clinic EHR system or paper records to the Alliance by the DST contractual deadline. Visits that were originally billed under the mother’s Medi-Cal ID need to be submitted under the child’s Medi-Cal ID. 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.

• Well-visits should occur at the following intervals:
  

  Birth (at the hospital)	6 months old
  3-5 days (after hospital discharge)	9 months old
  1 month old	12 months old
  2 months old	15 months old
  4 months old

  See the Bright Futures/American Academy of Pediatrics Recommendations for Preventive Pediatric Health Care for a comprehensive schedule up to 21 years of age, as well as the Bright Futures Materials and Tools.

• Catch up: Well-child visits are billable every two weeks until the day before the child’s 3^rd birthday For example, if an infant has their two-month well-child visit at three months of age, the infant can still be seen for their four-month visit if the visits are two weeks apart.
• Schedule the next six-month's visits before the member leaves the exam room or clinic and provide an overview of what is covered during the next visit. This ensures the child stays on schedule for the necessary 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 method ensures 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).
• Monitor the Provider Portal reports 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.
• Promote healthy behaviors and assess for risky behaviors to detect conditions that may interfere with physical, social and emotional development.
• Ensure that all children receive developmental screenings, at minimum, at nine months, 18 months, 24 or 30 months of age. If the child is at a higher risk for developmental problems, there may need to be additional screenings.
• Group well-child visits are 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 Recommended Child and Adolescent Immunization Schedule and Vaccines for Your Children for talking point 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.

• 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)
• The Alliance Infant Wellness Map is available to providers upon request. This resource gives parents awareness of the importance and timing of infant well-care visits, immunizations, and developmental milestones. Contact your Provider Relations Representative to request this resource for your clinic.
• Well Visit Planner – The Child & Adolescent Health Measurement Initiative.
• Well-Child Care: Improving Infant Well-Child Visits – Medicaid.gov.
• Maternal & Infant Health Care Quality – Medicaid.gov.
• Improving Preventive Care Services for Children Toolkit – CHCS.
• A Stepped Intervention Increases Well-Child Care and Immunization Rates in a Disadvantaged Population – AAP.
• Remove Roadblocks and Improve Access to Preventive Care – AAFP.
• Medi-Cal for Kids and Teens resources – DHCS.