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SSI Children Ambulatory Care

VBP.Disabled (SSI) Child: Children aged 0-20 years old.

Disables (SSI) Children aged 0-20 years as of December 31 of the measurement year who meet all of the following criteria during the calendar year:

  1. Enrolled in a disabled coverage group for 320 or more days
  2. Enrolled in a single HealthChoice MCO for 320 or more days
  3. Enrolled in the HealthChoice MCO as of December 31 of the measurement year
  4. Had no more than one gap in enrollment of up to 45 days during the measurement year

Best Practice and Measure Tips

This measure excludes

  • Inpatient admissions and emergency department services.

This measure includes

  • Ambulatory care visits with a behavioral health diagnosis code (mental or chemical dependency), if those visits were covered by the MCO.
  • At least one ambulatory care visit in an office or any PCP outpatient visit. Preventative well visits preferred.

Documentation via claims

  • This is a Maryland Department of Health (MDH) custom measure and reporting is captured by billing and encounter codes only.

Measure Codes

  • Urgent care center visit
    • S9083, S9088
  • Preferred Codes - preventive medicine CPT codes associated with this measure are contained in the following value sets:

  • Telephone Visits Value Set: CPT 98966-98968, 99441-99443.
  • Telephone Visits Modifiers: GT, 95:
  • GT: Via interactive audio and video telecommunication system.
  • 95: Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System.
  • Telehealth Place of Service (POS) 02:
  • E-visit or virtual check-in (Online Assessments Value Set): 98969-98972, 99421-99444, 99457, G0071, G2010, G2012, G2061-G2063
  • Outpatient visit (Outpatient Value Set): CPT: 99201-99205, 99211-99215, 99241-99245, 99341-99350, 99381-99385, 99391-99397, 99401-99404, 99411, 99412, 99429, 99455, 99456, 99483 G0402, G0438, G0439, G0463, T1015**.
  • Ambulatory outpatient visit: 92002, 92004, 92012, 92014, 99201-99205, 99211-99215, 99241-99245, 99304-99310, 99315, 99316, 99318, 99324-99328, 99334-99337, 99341-99350, 99381-99387, 99391-99397, 99401-99404, 99411, 99412, 99429, 99461, 99483, G0463, T1015**.
    • NOTE: **T1015 HCPCS code which identifies an all-inclusive clinic visit for services rendered at a Federally Qualified Health Center (FQHC)