Well-child visits

Services included in a well child visit

Each well child visit should document:

  • Health and developmental history (physical and mental)
  • Physical exam
  • Health education and anticipatory guidance
  • BMI percentile (counseling for nutrition and physical activity)

Well child visit billing

Follow these guidelines to avoid HEDIS® record audits for well child visits.

Documenting well child visit during a sick visit

  • When a sick patient comes in and is due for a well child visit, document all the components of a well child visit. They can be reported in addition to the problem-oriented visit.
  • Documentation must support that both services were provided in their entirety as significant and separately identifiable services. Then report the problem-oriented E&M service with the 25 modifier. This allows us to capture data for the well child visit and will reimburse for both services.

Sports physicals

If a child needs a sports physical for school and is due for a well child visit, complete all the services of a well child visit. Use appropriate diagnosis codes.

New patient preventive visits

Complete and document all well child visit components and report them.

Ages 0-30 months

  • Newborn visit 3-5 days post discharge
  • AT 2, 4, 6, 9, 12, 15, 18, 24 and 30 months (at least 6 visits in the first 15 months)
  • CPT codes 99381, 99382, 99391, 99392, 99461

Ages 3-6 years

  • 1 visit per year
  • CPT codes 99382, 99383, 99392, 99393

Ages 7-18 years

  • 1-2 visits per year from ages 7-10
  • 1 visit per year from ages 11-18
  • CPT codes 99384, 99385, 99394, 99395

Incentives

Well-child visits for 0-15 months, 3–6 year olds and 7-12 year olds are PCP Incentive Program (PCP-IP) measures.

To find patients needing well-child visits: Use the online Patient Profile tool to sort your patients by missed visits.