We would like to share some new developments from the Agency For Healthcare Administration relative to well-child visits. The Agency is allowing limited use of telemedicine to accomplish well child visits where safe to do so. This is a great opportunity to reach out to our members and your patients and ensure ongoing well visits are up to date.
Telemedicine Well-Child Visits: Children Older than 24 Months through 20 Years
The Agency understands that well-child visits are just as important as sick visits to ensure children receive quality care at their medical home. Florida Medicaid reimburses for well-child visits in accordance with the recommended schedule developed by the American Academy of Pediatrics. To promote health and wellness through preventive care during the COVID-19 state of emergency, the Agency is expanding telemedicine to include well-child visits.
Providers may render a well-child visit using telemedicine (live/two-way communication that includes audio and video) during the state of emergency for children older than 24 months through 20 years for the following procedure codes:
Providers must append the GT modifier for live, two-way communication. The Agency and the Medicaid health plans will reimburse the same rate as if the service was delivered face-to-face.
Though it may be necessary to conduct a well-child via telemedicine, it is the Agency’s expectation that providers actively work to schedule a follow-up visit to administer immunizations and other physical components of the exam that could not be delivered using telemedicine. Immunizations are critical to reducing and eliminating preventable diseases. Immunizations should be scheduled as soon as possible to ensure children can remain on schedule for these important services. The follow-up visit will eligible for Medicaid reimbursement. Additional guidance will be forthcoming regarding the follow-up visit to render the remaining components of the well-child visit (i.e., a comprehensive physical exam and/or immunizations) .
Well-Child Visits: Children 24 Months and Younger
In accordance with the American Academy of Pediatrics guidance, providers should prioritize in-person newborn care, newborn well-visits, and immunization of infants and young children through 24 months of age. Therefore, Florida Medicaid will not reimburse for well-child visits performed via telemedicine for children ages 24 months and younger.
Please reach out to our Provider Relations email at
[email protected] or your provider relations representative if you have any questions or would like to discuss ways we can partner to reach your patients and our members for well visits.
As always, thank you for all you are doing for our community and patients. Stay safe and healthy.
Lighthouse Health Plan
