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Child and Adolescent Well-Care Visits

EHP, Priority Partners, and USFHP. Members age 3-21 years.

The percentage of members 3–21 years of age who had at least one comprehensive well-care visit with a PCP or an OB/GYN practitioner during the measurement year. Report three age stratifications and a total rate:

  • 3–11 years.
  • 12–17 years.
  • 18–21 years.
  • Total.

Provider Specialty: PCP, OB/GYN

Best Practice and Measure Tips

  • Visits must be with a PCP. The PCP does not have to be the practitioner assigned to the child.
  • Assessment or treatment of an acute or chronic condition does not count towards the measure.
  • Well-Care Visits can be performed anytime in the measurement/calendar year.

To meet administrative measure requirements, JHHC reminds all LOB well-carevisits can be done in conjunction with sick visits, as long as they are billed appropriately.

How can a provider turn a sick visit into a well visit?

  • If provider is seeing a patient for Evaluation and Management (E/M) services and all well-child visit components are completed: Attach modifier 25 or 59 to the well-child procedure code so it’s reviewed as a significant, separately identifiable procedure.
  • Modifier 25 is used to indicate a significant and separately identifiable evaluation and management (E/M) service by the same physician on the same day another procedure or service was performed.
  • Modifier 59 is used to indicate that 2 or more procedures were performed at the same visit, but to different sites on the body.
  • Be sure to give addition guidance that is not related to the sick visit.
  • Examples:
    • Is the child wearing their seatbelt?
    • Discussion of oral health.
    • Document home or school life.
    • Are they participating in a team sport?
    • Are they adjusting to a new school?
    • Visit the Bright Futures website for more information about well-child visits (https://brightfutures.aap.org/materials-and-tools/guidelines-and-pocket-guide/).

Measure Exclusions

Required Exclusion: Hospice

Measure Codes

  • Be sure to use age-appropriate codes.
  • Well-Care Value Set
    • CPT HCPCS ICD-10 99381-99385, 99391- 99395, 99461 G0438, G0439, S0302 Z00.00, Z00.01, Z00.110, Z00.111, Z00.121, Z00.129, Z00.2, Z00.3, Z02.5, Z76.1, Z76.2