One of our primary goals is to ensure that all our members, and especially our youngest members, receive the preventive care they need from their providers.

We will continually provide materials and resources to help our participating providers complete Child and Adolescent Well-Child Visits for their patients in Health Partners (Medicaid) and CHIP plans.

Well-Child Visit Timeline

Your patients are eligible for a well-child visit once every year, even if 365 days have not yet passed since their last well-child visit in the prior calendar year. Providers will be reimbursed as long as it is a new calendar year.

For Example:

A Well-Child Visit takes place on January 1, 2023, and the next visit takes place on December 30, 2023. This is NOT reimbursable.
A Well-Child Visit takes place on February 1, 2023, and the next visit takes place on January 15, 2024. This is reimbursable.

Combined Sick Visits and Well-Child Visits

Your office can submit claims for both a sick visit and a preventive well-child visit for services provided on the same day, provided that the Modifier 25 is added to the claim if appropriate.

Please note the following coding reminders/clarifications:

•  As necessary, modifier 25 should be billed in the first modifier position with the applicable E&M code for the allowed sick visit. If modifier 25 is not billed in the first position, the sick visit may be denied.

•  Providers can bill the age-appropriate preventive CPT codes (99381-99385, 99391, 99392- 99395), and 99461) and a separate identifiable E&M code with the modifier 25, when appropriate.

•  Well-child visits can be reported with the following diagnosis codes: Z00.00, Z00.01, Z00.5, Z00.8, Z00.110, Z00.111, Z00.121, Z00.129, Z02.0-Z02.6, Z02.71, Z02.82, Z76.1, and Z76.2.

•  Appropriate diagnosis codes must be billed for the respective well-child visit and sick visit.

Examples of Proper Coding

a. New Patient E&M Visit

Well-child Visit Diagnosis Code (in the primary position): Z00.121
Well-child Visit E&M Code: 99382
Allowable Sick Visits with Modifier 25 (when billing with a well-child visit): 99202-25

b. Established Patient E&M Visit

Well-child Visit Diagnosis Code (in the primary position): Z00.121
Well-child Visit E&M Code: 99392
Allowable Sick Visits with Modifier 25 (when billing with a well-child visit): 99212-25

c. Established Patient E&M Visit

Well-child Visit Diagnosis Code (in the primary position): Z00.129
Well-child Visit E&M Code: 99394
Allowable Sick Visits with Modifier 25 (when billing with a well-child visit): 99213-25

Note: Providers must have proper medical record documentation to support the CPT codes and the E/M codes billed. This documentation should be able to be separated into two distinct notes that will support both E/M services billed for the visit.

Well Child Visit Tools

• CDC’s Developmental Milestones – available in English and Spanish
• Developmental Milestone Resources for WIC Programs – available in English and Spanish
• Penn State Extension: ABCs of Growing Healthy Kids – available in English and Spanish