Pediatric HEDIS Measures
Click the links below to review guidance on the medical record documentation required to be submitted to close HEDIS care gaps for Children and Adolescents.
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Age 13 years Documentation required for Gap Closure Immunization record, progress note or a certificate of immunization (ie NJIIS form) with dates, documented name of vaccine and/or illness for: - HPV: At least two vaccines between 9th and 13th birthday (for 2-dose series, there must be at least 146 days between both or 3-dose series on different dates of service)
- MCV: One vaccine between 11th and 13th birthday
- Tdap: One vaccine between 10th and 13th birthday
Combo 1: MCV and Tdap;
Combo 2: HPV, MCV and Tdap
Product(s) Impacted - Medicaid
- Commercial
Applicable HEDIS Program Primary Care Provider -
Age 9-26 months Documentation required for Gap Closure Lab report, progress note, or NJIIS form indicating the date AND result of the lead test
EPSDT (State Contract): 2 lead tests are required as follows:- Between nine (9) months and eighteen (18) months of age – target age twelve (12) months
- Between eighteen (18) months and twenty-six (26) months of age – target age twenty-four (24) months
Product(s) Impacted Medicaid Applicable HEDIS Program Primary Care Provider -
Age 3-17 years Documentation required for Gap Closure Documentation of height, weight and either of the following in the measurement year: - BMI percentile documented as a value (e.g. 85th percentile)
- BMI percentile plotted on an age-growth BMI chart
- Ranges and thresholds do not meet criteria for the BMI percentile (e.g. 25%-50%, >95%, etc.).
- Member reported biometric values (height, weight, BMI percentile) are acceptable when associated with a telehealth visit.
- BMI value does not count as BMI percentile
WCC Tip: Measure indicators can take place during a visit other than a well-child visit as long as the services are not specific to the assessment or treatment of an acute or chronic condition.Product(s) Impacted Medicaid
CommercialApplicable HEDIS Program Primary Care Provider -
Age 3-17 years Documentation required for Gap Closure Documentation must note the date and at least ONE of the following in the measurement year: - Discussion of current nutrition behaviors (e.g., eating habits, dieting behaviors)
- Checklist indicating nutrition was addressed
- Counseling or referral for nutrition education
- Member received educational materials on nutrition during a face-to-face visit
- Anticipatory guidance for nutrition
- Weight or obesity counseling
WCC Tip: Measure indicators can take place during a visit other than a well-child visit as long as the services are not specific to the assessment or treatment of an acute or chronic condition.Product(s) Impacted Medicaid
CommercialApplicable HEDIS Program Primary Care Provider -
Age 3-17 years Documentation required for Gap Closure Documentation must note the date and at least ONE of the following in the measurement year: - Discussion of current physical activity behaviors (e.g., exercise routine, participation in sports activities, exam for sports participation)
- Checklist indicating physical activity was addressed
- Counseling or referral for physical activity
- Member received educational materials on physical activity during a face-to-face visit
- Anticipatory guidance for physical activity
- Weight or obesity counseling
WCC Tip: Measure indicators can take place during a visit other than a well-child visit as long as the services are not specific to the assessment or treatment of an acute or chronic condition.Product(s) Impacted Medicaid
CommercialApplicable HEDIS Program Primary Care Provider -
Age On or before 2nd birthday Documentation required for Gap Closure Immunization record, progress note or a certificate of immunization (ie NJIIS form) with dates, documented name of vaccine and/or illness ON OR BEFORE the child's second birthday: - DTaP (4 doses on different dates between 42 days old and 2 years old)
- IPV (3 doses on different dates between 42 days old and 2 years old)
- Hepatitis B (3 doses on different dates by 2 years old)
- HiB (3 doses on different dates between 42 days old and 2 years old)
- Pneumococcal conjugate (4 doses on different dates between 42 days old and 2 years old)
- MMR (1 dose between first and second birthdays)
- VZV (1 dose between first and second birthdays)
- Hepatitis A (1 dose between first and second birthdays)
- Influenza (2 doses on different dates by 2 years old)
- Rotavirus (at least 2 doses on different dates by 2 years old); any of the below meet compliance:
- At least 2 doses of two-dose vaccine
- At least 3 doses of three-dose vaccine
- At least 1 dose of the two-dose vaccine and at least 2 doses of the three-dose vaccine
- A note stating the “member is up to date” with all immunizations, but does not list them, is not considered compliant.
- For Rotavirus, if documentation does not specify whether the two- or three-dose schedule was used, it will be assumed that three doses were administered.
Combinations Accepted Combo-10 (DTap, IPV, HepB, HIB. PCV, MMR, VZV, HepA, Rotavirus and Influenza)
Combo-7 (DTap, IPV, HepB, HIB. PCV, MMR, VZV, HepA, Rotavirus)Product(s) Impacted Medicaid
CommercialApplicable HEDIS Program Primary Care Provider