Key to Know… Changes to Well-Child Measures in 2020

Last update: October 2, 2020

There have been several recently announced changes to the well-child measures that are reported through HEDIS. The following measures will be retired: (1) Adolescent well-care visits (AWC); (2) Well- child 3-6-year-olds (W34); and (3) Well-child 15 months (W15). Below is a snapshot of these measure changes.  Two noteworthy changes are the change to administrative-only (claims) rate submission and telehealth visits counting in the measurement calculation.

***These measures will be incorporated into quality rewards program (provider P4P) for 2020 dates of service.

Well-Child Visit Measures:

  1. Well-Child Visits in the First 30 Months of Life (W30). – The percentage of members who had well-child visits during the last 15 months
    • Two measurements now included in this measure:
      • Children who turned 15 months old during the measurement year: (Six or more well child visits)
      • Children who turned 30 months old during the measurement year: (Two or more well child visits)
  2. Child and Adolescent Well-Care Visits. (WCV)– The percentage of enrolled members ages 3-21 years who had at least one comprehensive well-care visit with a PCP or an OB/GYN practitioner during the measurement year. (AWC and WC34 now included here)

***No chart auditing/review will be incorporated into rate final submission for these measures. We must receive the claim for you to get credit for these services.

Telehealth Updates for Well-Child Visits

  • Synchronous  telehealth – requires real-time interactive audio and video telecommunications) counts toward member compliance for  well- care measures W30 and WCV. ( Claims-based only measures/no hybrid chart review)
  • For  well- care  synchronous  telehealth,  providers should bill a well-visit code along with either a CPT telehealth modifier or the telehealth  place of  service. ( Please use well- visit diagnosis and procedure codes as you have previously)
  • Telehealth modifiers and POS should be used when billing for Telehealth Developmental Screening (CPT 96110)

If you have any questions about these changes, please contact your CPC (Clinical Practice Consultant) or provider advocate for your office. You can also visit NCQA.org for more information.