Metabolic Monitoring for Children and Adolescents on Antipsychotics Reminder

Date: October 4, 2021 Attention: Primary Care and Behavioral Health Providers Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event. Call to action: Texas Children’s Health Plan (TCHP) is actively working on a Performance Improvement Project (PIP) for members, ages 1-17, who are taking antipsychotic medications. This PIP is part of our quality management program and addresses the need for continuous monitoring for medication side effects. How this impacts providers: The aim of this PIP is to increase member adherence with annual blood glucose and cholesterol monitoring. Antipsychotics are known to be associated with weight gain and obesity, metabolic disturbances, hyperprolactinemia, and a number of other adverse health effects. As such is it recommended that metabolic screening be done prior to initiation and during treatment with an antipsychotic medication, particularly the second generation antipsychotics (SGA). This metric is supported by national projects and organizations including the Pediatric Quality Measures Program (PQMP)*, the American Academy of Child and Adolescent Psychiatry, and the Food and Drug Administration. It is also one of the Healthcare Effectiveness Data and Information Set (HEDIS®) measures. Member adherence with this metric is monitored through administrative data (claims). Below are glucose and cholesterol tests recognized by HEDIS:

Metabolic Monitoring	Acceptable Tests	CPT Codes		Testing Requirements
Blood Glucose	Blood glucose (Glucose Lab Test Value Set, Glucose Test Result or Finding Value Set) OR HbA1c (HbA1c Lab Test Value Set, HbA1c Test Result or Finding Value Set)	80047 80048 80050 80053 80069	82947 82950 82951 83036 83037	Fasting is not required for HbA1C testing.
Cholesterol	LDL-C (LDL-C Lab Test Value Set; LDL-C Test Result or Finding Value Set) OR Cholesterol (Cholesterol Lab Test Value Set; Cholesterol Test Result or Finding Value Set)	80061 82465 83700 83701 83704	83718 83721 83722 84478	Fasting 9-12 hours prior to lab draw is recommended for some higher-risk groups such as those with high triglycerides, but is not required.2

  Next steps for providers: Providers should ensure that their patients currently prescribed antipsychotic medications come in for annual metabolic testing or perform the testing at their next scheduled visit. If you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org.For access to all provider alerts,log into: www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.