Well-Child Visits Within the First 15 Months of Life

Aug. 21, 2019

At Blue Cross and Blue Shield of Texas, we are committed to offering support and resources to physicians to achieve the highest level of care possible for their patients, our members, to achieve the best possible health outcomes. Thank you for your dedication to ensure that your patients receive exceptional care.

Healthcare Effectiveness Data and Information Set® (HEDIS) was developed and is maintained by the National Committee for Quality Assurance (NCQA) to standardize and measure quality for all patients. The Office of Personnel Management (OPM) reviews HEDIS performance of certain measures for the Federal Employee Program (FEP) members. One of these measures focuses on well-child visits for infants and children within the first 15 months of life (W15). With the assistance of the Centers for Medicare & Medicaid Services (CMS) and the American Academy of Pediatrics, NCQA has developed this measure with a goal to promote optimal health outcomes for infants and children through regular well-child visits.

Medical record documentation must include a comprehensive visit note from the primary care physician, date of the visit, history to include physical health, physical development, mental development, a physical exam, and health education and recommendations. Documentation of these metrics is appropriate to demonstrate a well-child visit when performed by a primary care physician. Well-child exams may be performed even if the office visit is to treat illness.

Generally, it is recommended that infants and children receive at least six well-child visits within the first 15 months of life. The ages for well-child visits, as recommended by the American Academy of Pediatrics' Bright Futures Periodicity Schedule, are:

  • Newborn
  • One month
  • Two months
  • Six months
  • Nine months
  • Twelve months
  • Fifteen months

Below is a chart for easy access for commonly-used routine office visit codes. For your reference, the following are just a few of the approved codes from NCQA. For a complete list, please refer to the NCQA website.