UNDERSTANDING BILLING: What is a Well Child Visit?

The services provided as part of a well child visit are generally defined by the health insurance company.

Well child visits (routine preventive care)

• Assess growth and development

• Breastfeeding support

• Basic nutritional guidance and exercise recommendations

• Routine vaccinations

• Screening for medical and psychosocial problems (review the screening questionnaires you filled out before the visit)

• Anticipatory guidance (what to expect coming up)

An additional visit code will be billed when:

• A significant problem is identified that requires management, which includes diagnostic testing, referral to a specialist, or prescription of a new medication. 

• There is a significant change in treatment for an existing problem.

• Chronic problems are managed during the visit, like detailed review of the existing treatment plan or consultants’ notes, a new diagnostic workup, or a change in treatment. 

Care beyond the routine well child visit will be billed alongside the well child code, and you may be responsible for a portion of the charge (copay, coinsurance, deductible).

The alternative is returning another day for a separate problem visit.

Schedule a problem visit when you have concerns or questions about a problem.