Product Lines:
Advantage MD, EHP, Priority Partners, and USFHP.

Measurement Period: January 1–December 31.

Description:
The percentage of persons 20 years of age and older who had an ambulatory or preventive care visit. The organization reports three separate percentages for each product line.

• Persons enrolled in Medicaid and Medicare who had an ambulatory or preventive care visit during the measurement period.
• Persons enrolled in commercial who had an ambulatory or preventive care visit during the measurement year or the 2 years prior to the measurement period.

Stratifications:
Age as of the last day of the measurement period.

• 20–44 years.
• 45–64 years.
• 65 years and olderr.

Data Collection:

• Administrative.

Initial Population:

• Measure Item Count: Person.
• Age: 20 years of age and older as of the last day of the measurement period.
• Benefits: Medical.
• Continuous Enrollment:
  • Medicaid and Medicare: The measurement period.
  • Commercial: The measurement period and 730 days prior to the measurement period.
• Allowable Gap: No more than one gap of ≤45 days during each year of the continuous enrollment period. No gaps on the last day of the measurement period.

Denominator:

• The initial population minus denominator exclusions.

Numerator:

• Medicaid and Medicare: One or more ambulatory or preventive visits during the measurement period.

Commercial: One or more ambulatory or preventive visits during the measurement period or the 2 years prior to the measurement period.

Best Practice and Measure Tips

• Ensure members are seen within specified timeframes for each line of business.
• Report all services provided and utilize appropriate billing codes.
• Educate patients on the importance of having at least one ambulatory or preventive care visit during each calendar year.
• Consider offering expanded office hours to increase access to care.
• Keep a few open appointment slots each day to see patients the day they call.
• Contact patients who have not had a preventive or ambulatory health visit.
• Make reminder calls to patients who have appointments to decrease no-show rates.

Measure Exclusions

Denominator Exclusions:

• Persons in hospice or using hospice services any time during the measurement period.
• Persons who died any time during the measurement period.

Measure Codes

Use the following code to identify ambulatory or preventive care visits:

Ambulatory Visits

• CPT: 92002, 92004, 92012, 92014, 98000, 98001, 98002, 98003, 98004, 98005, 98006, 98007, 98008, 98009, 98010, 98011, 98012, 98013, 98014, 98015, 98016, 98966, 98967, 98968, 98970, 98971, 98972, 98980, 98981, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99242, 99243, 99244, 99245, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99315, 99316, 99341, 99342, 99344, 99345, 99347, 99348, 99349, 99350, 99381, 99382, 99383, 99384, 99385, 99386, 99387, 99391, 99392, 99393, 99394, 99395, 99396, 99397, 99401, 99402, 99403, 99404, 99411, 99412, 99421, 99422, 99423, 99429, 99441, 99442, 99443, 99457, 99458, 99483
• HCPCS: G0071, G0402, G0438, G0439, G0463, G2010, G2012, G2250, G2251, G2252, S0620, S0621, T1015**
  NOTE: **T1015 HCPCS code which identifies an all-inclusive clinic visit for services rendered at a Federally Qualified Health Center (FQHC)
• SNOMED CT US Edition: 18170008, 19681004, 162651007, 162655003, 170107008, 170114005, 170123008, 170132005, 170141000, 170150003, 170159002, 170168000, 170250008, 170254004, 170263002, 170272005, 170281004, 170290006, 170300004, 170309003, 185317003, 207195004, 209099002, 210098006, 243788004, 268563000, 268565007, 281029006, 281031002, 314849005, 386472008, 386473003, 401140000, 401267002, 410620009, 410622001, 410623006, 410624000, 410625004, 410626003, 410627007, 410628002, 410629005, 410630000, 410631001, 410632008, 410633003, 410634009, 410635005, 410636006, 410637002, 410638007, 410639004, 410640002, 410641003, 410642005, 410643000, 410644006, 410645007, 410646008, 410647004, 410648009, 410649001, 410650001, 442162000, 699134002, 712791009, 713020001, 783260003, 1269517007, 1269518002
• UBREV: 0510, 0511, 0513, 0514, 0515, 0516, 0517, 0519, 0520, 0521, 0522, 0523, 0524, 0525, 0526, 0527, 0528, 0529, 0982, 0983
  Reason for Ambulatory Visit
• ICD-10-CM: Z00.00, Z00.01, Z00.121, Z00.129, Z00.3, Z00.5, Z00.8, Z02.0, Z02.1, Z02.2, Z02.3, Z02.4, Z02.5, Z02.6, Z02.71, Z02.79, Z02.81, Z02.82, Z02.83, Z02.84, Z02.89, Z02.9, Z76.1, Z76.2