NAME CHANGE and REVISED DESCRIPTION – Child and Adolescent Well-Care Visits -(WCV)
| Date: | December 08, 2021 |
| To: | Health Plan of San Joaquin (HPSJ) Contracted Providers, Pediatrics and OB/GYN Offices |
| Provider Alert Type: | Informational/Educational |
| From: | Health Plan of San Joaquin |
| Subject: | NAME CHANGE and REVISED DESCRIPTION – Child and Adolescent Well-Care Visits -(WCV) |
| Business: | Medi-Cal MANAGED CARE |
REMINDER: The HEDIS measures (W34) Well Child Visits in the 3rd,4th,5th, and 6th Years of age & (AWC) Members 12-21 years of age during the measurement year, is now One Measure. The revised Child and Adolescent Well-Care Visits (WCV) HEDIS Measure is a combined measure and has added members aged 7-11 years.
Description:
(WCV)- Members 3-21 years of age who had at least on a comprehensive well-care visit with a PCP or an OB/GYN practitioner annually.
The medical record must include a note indicating a visit with a PCP or an OB/GYN, the date when the well-child visit occurred and evidence of all the following:
- Physical history
- Health 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 with the visit code
- Place of Service code 02 should also be billed
Complete well-child visits use these preventive CPT visit codes: 99381-99385 (new patient)
For more coding and documentation tips see our HEDIS 2021-2022 Gaps in Care
Documentation & Billing Guide for Providers at the following link.
If you have questions, please contact Provider Services at 1.888.936 PLAN (7526)