The HEDIS Adults' Access to Preventive/Ambulatory Health Services (AAP) measure evaluates whether adult patients age 20 and older have at least one qualifying ambulatory or preventive care visit. For Medicaid and Medicare patients, one qualifying visit during the measurement year closes the gap.
Coding Quick Guide
Common reasons why a completed visit doesn't close an AAP gap
- A qualifying Evaluation and Management (E&M) code or preventive visit code wasn’t billed. The patient was seen, but the submitted claim only included ancillary services, procedures, injections, testing, or screenings. Without a qualifying office visit or preventive care code, the visit may not be counted.
- The encounter was submitted as a laboratory-only service. Laboratory claims do not qualify for AAP. Claims billed with Place of Service code POS 81 (Independent Laboratory) are excluded from measure compliance, even when clinically appropriate testing was performed.
- Coding or claim submission errors prevented recognition of the visit. Incorrect CPT coding, place-of-service errors, claim denials, or delayed claim submission can prevent an otherwise qualifying encounter from being captured. Review of claim accuracy can often identify missed opportunities for measure closure.
Provider Tip: If a patient appears on an AAP gap list, despite being seen during the year, review the claim before scheduling additional outreach. Many unresolved gaps are related to coding or claim submission issues rather than missed care. If you would like a copy of members on the APP gap list, please reach out to qualityimprovement@selecthealth.org.
Why closing AAP gaps benefits your practice
- Ensures you receive credit for the care you deliver: Accurate coding and claim submission help ensure qualifying encounters are reflected in quality reporting and value-based care programs.
- Supports patient care: Routine preventive and ambulatory visits help identify health concerns earlier, support chronic disease management, and strengthen continuity of care.
- Strengthens ongoing patient engagement: Patients who maintain regular contact with their primary care team are more likely to complete recommended screenings, preventive services, and follow-up care.
By ensuring qualifying visits are coded accurately and submitted correctly, you can help close AAP gaps, support better patient outcomes, and ensure your practice receives appropriate recognition for the quality of care you provide every day.