Nov. 1, 2024
As a reminder, when children come into state custody, they must have a comprehensive well child checkup within 30 days.
Scheduling the checkup: The child’s caregiver is responsible for scheduling the well child checkup with the child’s primary care provider, school-based health center, federally qualified health center, rural health clinic or tribal provider. Managed care organizations will utilize available internal resources to contact the child’s caregiver to help ensure that the well child visit is scheduled within the 30 days.
About Children in State Custody: CISC are children and youth in the legal custody of the Children Youth & Family Department’s Protective Services division. This includes Native American children and children never removed from the respondent’s home or children returned to the respondent’s home following a removal. Respondents are defendants in an abuse and neglect case under the New Mexico Children’s Code.
Visit guidelines and codes: CISC visits follow Early and Periodic Screening, Diagnostic and Treatment tot-to-teen healthcheck guidelines for well child visits. The list of Current Procedural Terminology (CPT®) codes below should be billed with CISC specific diagnosis codes. For identification and tracking purposes, diagnosis code Z62.21 − Child in Welfare Custody must accompany the required diagnosis codes for initial or periodic screenings.
| Well Visit Codes | New Patient |
| 99381 | Infant (younger than 1 year) |
| 99382 | Early childhood (age 1–4 years) |
| 99383 | Late childhood (age 5–11 years) |
| 99384 | Adolescent (age 12–17 years) |
| 99385 | 18 years or older |
| Established Patient | |
| 99391 | Infant (younger than 1 year) |
| 99392 | Early childhood (age 1–4 years) |
| 99393 | Late childhood (age 5–11 years) |
| 99394 | Adolescent (age 12–17 years) |
| 99395 | 18 years or older |
| Evaluation and Management Codes | |
| 99202 - 99205 | New patient |
| 99212 - 99215 | Established patient |
Refer to our EPSDT Clinical Practice and Billing Guideline for more details on well child visits.