North Carolina Medicaid: Schedule well-child visits early

You can schedule the 2-year well-child visit before the child’s second birthday for UnitedHealthcare Community Plan of North Carolina members. The visit is fully reimbursable and does not need to occur on or after the birthday.

North Carolina Medicaid does not require well-care visits (ages 3–21) to be 365 days apart. The visit is covered per calendar year.

Why this matters

Childhood immunization status – Combination 10: Children who turn 2 during the calendar year must have required vaccine series completed by the second birthday. Vaccines administered after the second birthday, even by 1 day, do not count toward CIS Combo 10 compliance. Scheduling before age 2 creates time to review gaps and administer due vaccines.
Well-child visits in the first 30 months of life: Children ages 15–30 months need at least 2 well-child visits during the measurement period. The 2-year well-child visit may be the last key opportunity to meet this measure.
Child and adolescent well-care visits: Children and adolescents ages 3–21 need at least 1 comprehensive well-care visit with a primary care provider or OB-GYN during the measurement year. North Carolina Medicaid does not require these visits to be 365 days apart.

Completing well-child visits can help close well-care gaps. Use the chart below to identify codes that may help close those gaps:

Code	Brief description	Code	Brief description
99381	New pt preventive, infant	99382	New pt preventive, 1–4 years
99383	New pt preventive, 5–11 years	99384	New pt preventive, 12–17 years
99385	New pt preventive, 18–39 years	99391	Established preventive, infant
99392	Established preventive, 1–4 years	99393	Established preventive, 5–11 years
99394	Established preventive, 12–17 years	99395	Established preventive, 18–39 years
99461	Initial newborn care	G0438	Initial annual wellness visit
G0439	Subsequent annual wellness visit	S0302	Completed EPSDT service
S0610	Annual GYN exam, new pt	S0612	Annual GYN exam, established pt
S0613	Annual GYN exam, no pelvic

Select the code that matches the member age, patient status and services rendered. Billing a code does not replace North Carolina Medicaid policy, documentation, medical necessity or contract requirements.

Use modifier EP for eligible ages 0–20 when the service is part of a health check/EPSDT early periodic screening encounter.