CommercialCoverageMedium impact
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
Mar 1, 2020
We identified it
Jun 19, 2026
Summary
BCBSRI has updated their HEDIS quality measure requirements for follow-up care of children (ages 6-12) prescribed ADHD medication. The policy requires one follow-up visit within 30 days of initial prescription and at least two additional visits within 9 months, with specific telephone codes now covered but not separately reimbursed.
Action Required
Immediately: Update billing workflows to track ADHD medication follow-up visits for children ages 6-12. Schedule required follow-up visits (one within 30 days, two more within 9 months) at time of initial prescription. Document that telephone codes 98966, 98967, 98968, 99441, 99442, and 99443 can be used for continuation phase visits but are covered with no separate reimbursement by BCBSRI. Ensure controlled substance patients have at least two visits per year documented for progress evaluation.