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HEDIS® Tip Sheet

Annual Preventative Visits for Adults

Line of business: BlueAlliance Care+ (Medicaid Expansion)

Measure Description

The percentage of attributed members ages 22-64 years of age who had at least one comprehensive well-care visits with a PCP or an OB/GYN practitioner during the measurement year.

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Notes

  • The denominator is all attributed members 22-64 years of age as of 12/31 of the measurement year.
  • The numerator is the number of attributed members 22-64 years of age who had at least one comprehensive well-care visit with a PCP or an OB/GYN practitioner during the measurement year.
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Best Practices

  • Educate patients and providers on the value of annual preventive care and its role in long-term health.
  • Schedule the next visit before the patient leaves their current appointment to ensure continuity of care.
  • Make scheduling easier by promoting the patient portal for booking, reminders, and care info, and offering a self-scheduling option for more flexibility.
  • Train providers and staff to proactively monitor and reach out to patients who are due for preventive care.
  • Leverage EMR tools, including reports and patient flags, to identify individuals in need of preventive services.
  • Send appointment reminders to patients via phone, text, or email to reduce no-shows and improve attendance.
  • Reserve daily appointment slots for same-day preventive visits to accommodate patient needs.
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Exclusions

  • Services provided in an acute inpatient setting.
  • Members on hospice services during the measurement year.
  • Members who died during the measurement year.

Coding:

This measure is identified with codes including, but not limited to: 99381-99384, 99391-99395, 99461

Coding Disclaimer

The analysis of any medical coding question related to a measure is dependent on the measure’s technical specifications including the factual situations present related to the member, the practice, the professionals, and the medical services provided.

Questions  

Should you have specific coding or other questions related to the measure, please send your questions to BlueAlliance@bcbsnd.com.

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HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).

Updated 7/16/2025