Follow-Up Care for Children Prescribed ADHD Medication (ADD)

Initiation phase: The percentage of children ages 6-12 as of the index prescription date (IPSD). Should have ambulatory prescription dispensed for ADHD medication and one follow-up visit with a practitioner with prescribing authority. Follow-up visit should occur in the first 30 days of the prescription dispensation.
Continuation & maintenance phase: The percentage of children ages 6-12, as of the IPSD. Should have an ambulatory prescription dispensed for ADHD medication and should remain on medication for at least 210 days. In addition, the initiation phase should have had at least two follow-up visits with a practitioner, occurring within 270 days (nine months) after the initiation phase has ended.

• When prescribing new ADHD medication, schedule a follow-up visit within 30 days to assess how the medication is working. Schedule this visit while your patient is still in your office.
• Schedule two additional visits in the nine months after the first 30 days to continue monitoring your patient’s progress.
• Telephone codes can help satisfy the requirements for the Continuation & Maintenance phase part of the measure. Codes 98966, 98967, 98968, 99441, 99442, and 99443 are covered but not separately reimbursed by BCBSRI. If the patient is not seen face-to-face, but instead completes a follow-up call, these codes may satisfy the numerator for the continuation measure.
• Controlled substances should not be reordered without at least two visits per year to evaluate a child’s progress and growth.