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Follow-Up Care for Children Prescribed ADHD Medication (ADD)

Based on current NCQA HEDIS recommendations, your TO-DO LIST for children newly prescribed attention-deficit/hyperactivity disorder (ADHD) medications should include:

  • Follow-up visits within 30 days of prescribed ADHD medication dispensed
  • Two additional follow-up visits within 10 months of prescribed ADHD medication dispensed

Why should you complete your TO-DO LIST?

It is an evidence-based, best practice and these actions are used to measure your quality performance.

Population definition for follow-up Care for children prescribed ADHD medication:

(NCQA HEDIS guidelines, Measurement Year (MY) 2022)

  • Members who are 6 years of age as of March 1 of the year prior to the measurement year and 12 years of age as of the last calendar day of February of the measurement year
  • Line of Business: Commercial, Medicaid

HEDIS Measures:

DESCRIPTION: PHASE: REQUIREMENT:
The percentage of members 6-12 years of age as of the IPSD* with an ambulatory prescription dispensed for ADHD medication, who had one follow-up visit with practitioner¹ with prescribing authority during the 30-day Initiation Phase Initiation Perform one visit within 30 days of ADHD medication dispense date.
The percentage of members 6-12 years of age as of the IPSD² with an ambulatory prescription dispensed for ADHD medication, who remained on the medication for at least 210 days and who, in addition to the visit in the Initiation Phase, had at least two follow-up visits with a practitioner* within 270 days (9 months) after the Initiation Phase ended Continuation and Maintenance (C&M) Perform two additional visits within 9 months after the Initiation Phase ended (total of 10 months). Only one of the two visits (during days 31-300) may be an e-visit or virtual check-in (Online Assessment Value Set).

¹Prescribing provider or Primary Care Provider (PCP) can complete the follow-up visit.

²IPSD - Index Prescription Start Date. The earliest prescription dispensing date for an ADHD medication where the date is in the Intake Period and there is a Negative Medication History.

ADHD Medications

Description: Prescription:
Alpha-2 receptor agonists
  • Clonidine
  • Guanfacine
CNS stimulants
  • Dextroamphetamine
  • Lisdexamfetamine
  • Methylphenidate
  • Dexmethylphenidate
  • Methamphetamine
Miscellaneous ADHD medications
  • Atomoxetine
 

How does your completion of the TO-DO LIST get recorded?

Codes Related to ADHD Management

BH Outpatient

CPT 98960 98961 98962 99078 99201 99202 99203 99204 99205 99211 99212 99213 99214 99215 99241 99242 99243 99244 99245 99341 99342 99343 99344 99345 99347 99348 99349 99350 99381 99382 99383 99384 99385 99386 99387 99391 99392 99393 99394 99395 99396 99397 99401 99402 99403 99404 99411 99412 99483 99492 99493 99494 99510

HCPCS G0155 G0176 G0177 G0409 G0463 G0512 H0002 H0004 H0031 H0034 H0036 H0037 H0039 H0040 H2000 H2010 H2011 H2013 H2014 H2015 H2016 H2017 H2018 H2019 H2020 T1015

SNOMED CT US Edition 77406008 84251009 185463005 185464004 185465003 281036007 391223001 391224007 391225008 391233009 391237005 391239008 391242002 391257009 391260002 391261003 439740005 3391000175108 444971000124105

UBREV 0510 0513 0515 0516 0517 0519 0520 0521 0522 0523 0526 0527 0528 0529 0900 0902 0903 0904 0911 0914 0915 0916 0917 0919 0982 0983


Community Mental Health Center POS

POS 53


Health and Behavior Assessment or Intervention

CPT 96150 96151 96152 96153 96154 96156 96158 96159 96164 96165 96167 96168 96170 96171


Observation

CPT 99217 99218 99219 99220


Online Assessments

CPT 98969 98970 98971 98972 99421 99422 99423 99444 99457

HCPCS G0071 G2010 G2012 G2061 G2062 G2063


Outpatient POS

POS 03 05 07 09 11 12 13 14 15 16 17 18 19 20 22 33 49 50 71 72


Partial Hospitalization or Intensive Outpatient

HCPCS G0410 G0411 H0035 H2001 H2012 S0201 S9480 S9484 S9485

SNOMED CT US Edition 7133001 305345009 305346005 305347001 391038005 391042008 391043003 391046006 391047002 391048007 391054008 391055009 391056005 391133003 391150001 391151002 391152009 391153004 391170007 391185001 391186000 391187009 391188004 391191004 391192006 391194007 391195008 391207001 391208006 391209003 391210008 391211007 391228005 391229002 391232004 391252003 391254002 391255001 391256000

UBREV 0905 0907 0912 0913


Partial Hospitalization POS

POS 52


Telehealth POS

POS 02


Telephone Visits

CPT 98966 98967 98968 99441 99442 99443

SNOMED CT US Edition 185317003 314849005 386472008 386473003 401267002


Visit Setting Unspecified

CPT 90791 90792 90832 90833 90834 90836 90837 90838 90839 90840 90845 90847 90849 90853 90875 90876 99221 99222 99223 99231 99232 99233 99238 99239 99251 99252 99253 99254 99255

To learn more about your practice’s current HEDIS performance for this or other measures, or for assistance in compliance with the HEDIS guidelines, please contact Horizon Healthy Journey:1-844-754-2451.

Reference: NCQA HEDIS Measurement Year (MY) 2022 Technical Specs CPT® is a registered trademark of the American Medical Association.