Product Lines:
Advantage MD, EHP, Priority Partners, and USFHP.

Eligible Population:
Members age 20 years of age and older as of December 31 of the measurement year.

Definition:
The percentage of members 20 years of age and older who had an ambulatory or preventive care visit. The organization reports three separate percentages for each product line.

• Medicaid and Medicare members who had an ambulatory or preventive care visit during the measurement year.
• Commercial members who had an ambulatory or preventive care visit during the measurement year or the 2 years prior to the measurement year.

Report three age stratifications and a total rate: 

• 20-44 years.
• 45-64 years.
• 65 years and older.
• Total. The total is the sum of the age stratifications.

Continuous Enrollment:

• Medicaid and Medicare: The measurement year.
• Commercial: The measurement year and the 730 days prior to the measurement year.

Best Practice and Measure Tips

• Ensure members are seen within specified timeframes for each line of business.
• Report all services provided and utilize appropriate billing codes.
• Educate patients on the importance of having at least one ambulatory or preventive care visit during each calendar year.
• Consider offering expanded office hours to increase access to care.
• Keep a few open appointment slots each day to see patients the day they call.
• Contact patients who have not had a preventive or ambulatory health visit.
• Make reminder calls to patients who have appointments to decrease no-show rates.

Measure Exclusions

Required Exclusion:

• Members in hospice or using hospice services anytime during the measurement year.
• Members who died any time during the measurement year.

Measure Codes

Use the following code to identify ambulatory or preventive care visits:

• Ambulatory Visits
  • CPT: 92002, 92004, 92012, 92014, 98966, 98967, 98968, 98970, 98971, 98972, 98980, 98981, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99241, 99242, 99243, 99244, 99245, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99315, 99316, 99318, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99381, 99382, 99383, 99384, 99385, 99386, 99387, 99391, 99392, 99393, 99394, 99395, 99396, 99397, 99401, 99402, 99403, 99404, 99411, 99412, 99421, 99422, 99423, 99429, 99441, 99442, 99443, 99457, 99458, 99483
  • HCPCS: G0071, G0402, G0438, G0439, G0463, G2010, G2012, G2250, G2251, G2252, S0620, S0621, T1015
  • UBREV: 0510, 0511, 0512, 0513, 0514, 0515, 0516, 0517, 0519, 0520, 0521, 0522, 0523, 0524, 0525, 0526, 0527, 0528, 0529, 0982, 0983
• Reason for Ambulatory Visit
  • ICD-10-CM: Z00.00, Z00.01, Z00.121, Z00.129, Z00.3, Z00.5, Z00.8, Z02.0, Z02.1, Z02.2, Z02.3, Z02.4, Z02.5, Z02.6, Z02.71, Z02.79, Z02.81, Z02.82, Z02.83, Z02.89, Z02.9, Z76.1, Z76.2