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Well-Child Visits in the First 30 Months of Life

Priority Partners. Member ages 15 months-30 months during measurement year.

Percentage of members who had the following number of well-child visits with a PCP during the last 15 months.

The following rates are reported:

  • Well-Child Visits in the First 15 Months. Children who turned 15 months old during the measurement year: Six or more well-child visits.
  • Well-Child Visits for Age 15 Months–30 Months. Children who turned 30 months old during the measurement year: Two or more well-child visits.

Provider Specialty: PCP

Best Practice and Measure Tips

  • Visits must be with a PCP. The PCP does not have to be the practitioner assigned to the child.
  • There must be at least two weeks between each well-child visit
  • Assessment or treatment of an acute or chronic condition does not count towards the measure.
  • To meet administrative measure requirements, JHHC reminds all LOB well-care visits can be done in conjunction with sick visits, as long as they are billed appropriately.
  • Well-care visits can be performed anytime in the measurement/calendar year.
  • If provider is seeing a patient for Evaluation and Management 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 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.
  • For members who are off-track, schedule a catch-up well-child visit appointment for each required evaluation.
  • At the new patient visit and every future visit, schedule the next well-child visit appointment.

Measure Exclusions

Required Exclusion: Hospice

Measure Codes

  • Well-Care Value Set
    • CPT HCPCS ICD-10 99381-99385, 99391-99395, 99461, G0438, G0439 , S0302, Z00.110, Z00.111, Z00.121, Z00.129, Z00.2, Z00.3 Z00.5, Z76.1, Z76.2