Child and Adolescent Well Care Visits Tip Sheet Form

Child and Adolescent Well Care Visits Tip Sheet In compliance with the Quality Assurance Reporting Requirements (QARR) and the Healthcare Efectiveness Data and Information Set (HEDIS) reporting requirements, Fidelis Care annually reviews the charts of selected members. For well care visits, providers should send Fidelis Care patients’ administrative data, such as claims or corrected claims, documenting: Compliant Well Care Visits Compliant Child and Adolescent Well Care Visits requires a minimum of 1 annual visit. ALL of the following must be included: • A health history: assessment of member’s history of disease or illness and family health history. • A physical development history: assessment of specifc age-appropriate physical development milestones. • A mental development history: assessment of specifc age-appropriate mental development milestones. • A physical exam. • Health education/anticipatory guidance: guidance given in anticipation of emerging issues that a child/family may face. Measure Description Appropriate Coding to meet the measure Child and Adolescent Well Care Visits (WCV): 99382, 99383, 99384, 99385, 99392, 99393, Children ages 3-21 as of December 31 of the measurement 99394, 99395, 99461, S0302, S0610, S0612, year who has had one or more comprehensive well care S0613, Z00.00, Z00.01, Z00.121, Z00.129, Z00.2, visits with a PCP or an OB/GYN. Visits must be submitted Z00.3, Z01.411, Z01.419, Z02.5, Z76.1, Z76.2, with the appropriate well-care coding. 99381, 99391 Chlamydia Screening in Women: 13705-9, 14958-3, 14959-1, 30000-4, 44292-1, Sexually active women ages 16-24 must receive a 59159-4, 76401-9, 77253-3, 77254-1, chlamydia test. Women may not want to share their sexual 89998-9, 9318-7 history with their PCP. Even if a woman does not share, she should have a urine analysis to test for chlamydia, especially if she is part of the non-compliant population for this measure. Always test a female patient for chlamydia if: • She had a pregnancy test and/or • She recently received prescription contraceptives Document provided courtesy of Fidelis Care Revised 5/21/25

Immunizations for Adolescents (Combination 2): Meningococcal Conjugate: 90734 Adolescents age 13 as of December 31 of the measurement -and­ year who have at least one meningococcal vaccine Tdap/Td: 90715, 90619, 90733 between their 11th and 13th birthdays, and at least one -and­ tetanus, diphtheria toxoids and acellular pertussis vaccine HPV: 90649, 90650, 90651 (Tdap) on or between their 10th and 13th birthdays, and at least two HPV vaccines with diferent dates of service on or between the child’s 9th and 13th birthdays. There must be at least 146 days between the frst and second HPV dose of the HPV vaccination, or at least three HPV vaccines with diferent dates of service. Appropriate Testing for Children with 87070, 87071, 87081, 87430, 87650, 87651, Pharyngitis Ages 3-18: 87652, 87880 When diagnosing children ages 3-18 with pharyngitis: • Perform a strep test at the point of care • Prescribe antibiotics if medically necessary Reminder - A sick child visit is an ideal time to conduct a well care examination. If you provide these two services on the same day (a sick visit, and a well care visit) and document them, please bill for both, using modifer 25. Previously submitted claims can be corrected to include the well care examination when appropriate. Corrected claims should be sent electronically using CLM05-3 Claim Frequency Type Code Element set to a 7 and 2300 Loop. REF Original Reference Number (ICN/DCN) Segment, where REF01 Element equals F8. REF02 Element must contain the Fidelis Care original claim number. If you have a School Based Health Center, please work with your Provider Partnership Associate to ensure those visits are captured. Document provided courtesy of Fidelis Care Revised 5/21/25