CommercialCoverageMedium impact
Follow-Up Care for Children Prescribed Attention Deficit Hyperactivity Disorder (ADHD) Medication
Blue Cross Blue Shield of Rhode Island·RI · Pediatrics, Family Medicine, Psychiatry·Behavioral Health
Effective date
Dec 1, 2019
We identified it
Jun 20, 2026
Summary
BCBS RI has updated guidelines for ADHD medication follow-up care in children, specifying required visit schedules for HEDIS compliance. The policy outlines billing requirements for telephone follow-up codes that can satisfy continuation phase requirements but are not separately reimbursed.
Action Required
Immediately: Billing team must update systems to recognize that telephone codes 98966, 98967, 98968, 99441, 99442, and 99443 are covered but not separately reimbursed by BCBSRI for ADHD follow-up care. Providers should schedule initial ADHD medication follow-up within 30 days and two additional visits within 9 months for HEDIS compliance. Update encounter forms to remind providers of required visit scheduling.