A helpful guide to covered well-child visits 

The American Academy of Pediatrics (AAP) developed a set of comprehensive health guidelines for well-child care. Known as the “periodicity schedule,” this screenings and assessments guideline provides a comprehensive schedule for each well-child visit, from infancy.

 

Schedule for well-child visits

 

The AAP recommends that children should have a total of eight visits before their 30-month birthday (six visits before they are 15 months) with annual visits thereafter. The AAP periodicity schedule aligns with the well-child visits in the first 30 months of life (W30) HEDIS® measure.  Ensuring all visits are completed before the child’s 30-month birthday is critical to assuring compliance with these measures. 

 

Complete coverage for well-child visits regardless of when visit is received

Well-child visits (WCV) are covered 100% regardless of when the visit is received. Payment is not dependent on a set schedule, so there is no requirement to wait for a milestone birth month to schedule the well-child visit.

 

HEDIS® measures W30 and WCV

• Well-child visits in the first 30 months of life (W30)
  Description: The 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 month to 30 months. Children who turned 30 months old during the measurement year: two or more well-child visits.
• Child and adolescent well-care visits (WCV)
  Description: The percentage of members 3 to 21 years of age who had at least one comprehensive well-care visit with a PCP or an OB/GYN practitioner during the measurement year.

 

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).

1133-0521-PN-NE