CommercialCoverageMedium impact
HEDIS Follow-Up Care for Children Prescribed ADHD Medication (ADD)
Blue Cross Blue Shield of Rhode Island·RI · Pediatrics, Family Medicine, Psychiatry·Behavioral Health
Effective date
Sep 1, 2021
We identified it
Jun 19, 2026
Summary
BCBS Rhode Island has established HEDIS quality measure requirements for children prescribed ADHD medication, requiring specific follow-up visit schedules and allowing certain telephone codes (98966-98968, 99441-99443) for continuation phase monitoring. This affects how providers document and bill for ADHD medication follow-up care to meet quality metrics.
Action Required
Immediately: Billing team must update workflows to ensure children prescribed ADHD medication have proper follow-up scheduling (within 30 days for initiation, plus 2 additional visits in 9 months). Use telephone codes 98966, 98967, 98968, 99441, 99442, 99443 for continuation phase visits when appropriate - these codes are covered but not separately reimbursed by BCBSRI. Providers must document these visits to satisfy HEDIS quality measures.