Product Lines:
EHP, Priority Partners, and USFHP.

Eligible Population:
Member ages 15 months-30 months during measurement year.

Definition:
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

Report stratification by race and ethnicity.

Continuous Enrollment:

• Well-Child Visits in the First 15 Months: 31 days–15 months of age. Calculate 31 days of age by adding 31 days to the date of birth.
• Well-Child Visits for Age 15 Months–30 Months: 15 months plus 1 day–30 months of age. Calculate the 15-month birthday plus 1 day as the first birthday plus 91 days.

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, Johns Hopkins Health Plans 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.
• This measure is based on the American Academy of Pediatrics Bright Futures: Guidelines for Health Supervision of Infants, Children and Adolescents (published by the National Center for Education in Maternal and Child Health). Visit the Bright Futures website for more information about well-child visits.

Measure Exclusions

Required Exclusion:

• Members in hospice or using hospice services anytime during the measurement year.
• Members who died any time during the measurement year.

Measure Codes

• Well-Care Codes
  • CPT: 99381, 99382, 99391, 99392, 99461
  • HCPCS: G0438, G0439, S0302
  • ICD-10-CM: Z00.110, Z00.111, Z00.121, Z00.129, Z00.2, Z76.1, Z76.2