Provider Alert! Infant Well-Child Visits Reminder
Date: April 18, 2023
Attention: Primary Care Providers
Call to action: Texas Children’s Health Plan (TCHP) encourages providers to ensure their infant patients are receiving timely well-child visits and immunizations, in compliance with the Texas Health Steps (THSteps) periodicity schedule. TCHP is committed to ensuring members recognize the importance of preventive care and is working with members to better understand and address member barriers to complying with the THSteps periodicity schedule. TCHP encourages providers to emphasize the importance of preventive care and assist with scheduling timely care for all patients.
Potential Provider Incentives: In order to assist and recognize providers who emphasize timely preventive care, providers may be eligible to participate in a Provider Incentive Program, which rewards primary care providers whose patients are compliant with the THSteps periodicity schedule within the first 15 months of life. The program has quarterly payouts and care must be captured administratively through claims.
Providers must qualify to participate in this program based on their panel size and network participation. If you are interested in learning more, please contact your assigned Provider Relations Liaison (PRL). If you are not aware of your assigned PRL, please email providerrelations@texaschildrens.org. We are excited to offer this to our network and encourage your participation.
Next steps for providers: Please schedule all required infant well-child appointments in advance and submit claims as soon as services are rendered. We kindly ask that providers submit claims timely so that they are compliant with the Healthcare Effectiveness Data and Information Set (HEDIS) measures. In doing so, you’re continuing to provide great care to our members while also having the opportunity to participate in the Provider Incentive Program. We ask that providers use appropriate codes to reflect the services for infant well-child visits. Additional information on appropriate coding is shown below:
Well-Child Visits in the First 30 Months of Life (W30)
(replaces W15, now also includes ages 15 to 30 months)
- Assesses children who turned 15 months old during the measurement year and who had at least 6 well-child visits with a PCP during their first 15 months of life.
- Assesses children who turned 30 months old during the measurement year and who had at least 2 well-child visits with a PCP between 15 and 30 months of life.
| Age Range | CPT Codes (new patients) | CPT Codes (established patients) | ICD-10 Diagnosis Codes |
| 0-7 days | 99381 | 99391 | Z00.110 |
| 8-28 days | 99381 | 99391 | Z00.111 |
| 29-364 days | 99381 | 99391 | Z00.121*, Z00.129 † |
| 12-30 months | 99382 | 99392 | Z00.121*, Z00.129 † |
* With abnormal findings
† Without abnormal findings.
Please refer to the HEDIS Quick Reference for Well-Child Visits for more information.
Providers are encouraged to share this communication with their staff and implement office management protocols that prioritize scheduling of timely well child care and immunizations. Providers are also encouraged to share education on the importance of timely preventive care with members.
For additional information on the importance of Infant Well-Child Visits, and information to share with patients, providers and staff can visit:
Texas Health Steps Medical Checkup Periodicity Schedule for Infants, Children and Adolescents
American Academy of Pediatrics – Bright Futures
HealthyChildren.Org – Your Child’s Checkups
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.
