Provider Alerts

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Date:	October 27, 2021
To:	Health Plan of San Joaquin (HPSJ) CONTRACTED PCPs and Pediatrics Offices
From:	Health Plan of San Joaquin
Subject:	NAME CHANGE and REVISED DESCRIPTION – Well-Child Visit (W30): Visits in the first 30 Months of Life (Formerly-W15)
Business:	Medi-Cal Managed Care

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The HEDIS measure (W15) Well-Child Visits in the First 15 Months of Life is replaced by (W30)
Well-Child Visits in the first 30 months of life.
The revised description has been expanded to include:

• Babies who turned 15 months old during the measurement year who had six or more wellchild visits and
• Babies who turned 30 months old during the measurement year who had two or more wellchild visits.

Medical record documentation must include a note indicating a well-child visit with a PCP, the date when the visit occurred, and evidence of all the following:

Medical record documentation must include a note indicating a well-child visit with a PCP, the date when the visit occurred, and evidence of all the following:

• Health history
• Physical history
• Mental history
• Physical exam
• Health Education/Anticipatory guidance

Coding and Billing:

• If a portion of a well-child visit is done via telehealth, use modifier 95 and place of service 02 with the visit code
• Complete well-child visits use these preventive CPT visit codes: 99381-99385 (new patient) or 99391-99395 (established patient)

For more coding and documentation tips, see our HEDIS 2021-2022 Gaps in Care
Documentation & Billing Guide for Providers at the following link: https://provider.hpsj.com/dre/modules/centauri/ProviderBillingTipsForHEDIS2021_2022_20210 920.pdf

If you have questions, please contact Provider Services at 1.888.936.PLAN (7526).