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 CBI Technical Specifications.

Members in hospice or using hospice services anytime during the measurement year.

Members who died any time during the measurement year (CBI 2024 only).

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, Z02.5

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

Please refer to the 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 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 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 American Academy of Pediatrics (AAP) Bright Futures Periodicity Schedule for a comprehensive schedule up to 21 years of age, as well as. materials and tools.

• Schedule the next 6-month visits before the member leaves the exam room or clinic and provide an overview of what will be covered at the next visit. This is to ensure the child stays on schedule for the necessary visits.
• Utilize telehealth visits for patients that do not feel comfortable coming into the clinic.
• Utilize 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 of ensuring 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 for identifying members that 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 occurring 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.
• Alliance interpreting services are available to network providers:
  • Telephonic interpreting services are available to assist in scheduling members.
  • Face-to-face interpreters can be requested to be at the appointment with the member.

  For information about our Cultural and Linguistic Services Program, please call the Alliance Health Education Line at 800-700-3874, ext. 5580 or email us at [email protected].

• Refer patients who have transportation challenges to the Alliance’s Transportation Coordinator at 800-700-3874, ext. 5577. This service is not covered for non-medical locations or for appointments that are not medically necessary.

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.

• The Child & Adolescent Health Measurement Initiative Well Visit Planner
• AAP's Guidance on Providing Pediatric Well-Care During COVID-19
• Maternal Infant Health Initiative: Infant Well-Child Visit Learning Collaborative
• Center for Health Care Strategies (CHCS) Improving Preventive Care Services for Children Toolkit
• AAP’s A Stepped Intervention Increases Well-Child Care and Immunization Rates in a Disadvantaged Population
• AAFP Remove Roadblocks and Improve Access to Preventive Care
• “Medi-Cal for Kids and Teens” DHCS developed child and teen focused brochures