HEDIS® Measure Focus: Testing for Children with Pharyngitis

HEDIS® Measure Focus: Testing for Children with Pharyngitis


We use Healthcare Effectiveness Data and Information Set (HEDIS) measures to identify potential gaps in care. We also use these measures to improve the overall health outcomes for your patients. We aim to give you measure-specific information to support your efforts in providing quality care to our members and avoid potential gaps in care.

Appropriate Testing for Children with Pharyngitis

A virus or bacteria can cause pharyngitis. Often, providers prescribe antibiotics without positive testing to confirm a bacterial infection. This can cause antibiotic resistance. This measure focuses on performing group A streptococcus (strep A) tests on children ages 2 to 18 to confirm strep.

This measure assesses the percentage who:

  • Were diagnosed with pharyngitis.
  • Received an antibiotic.
  • Received a strep A test.

What You Can Do

  • If a patient has a pharyngitis diagnosis, perform a strep A test.
  • Avoid prescribing antibiotics for children unless they have a positive strep A test.
  • If you are treating a patient for another condition or illness, document the other diagnosis code on the claim.
  • If an antibiotic is not necessary, use the Centers for Disease Control and Prevention (CDC) over-the-counter prescription pad available at http://www.cdc.gov/getsmart/campaign-materials/print-materials/ViralRxPad-bw.pdf. (This link leads to a third party site. That company is solely responsible for the contents and privacy policies on its site.) The CDC is an independent company that offers health education information on behalf of BlueCross BlueShield of South Carolina and BlueChoice HealthPlan.

Please contact Provider Education for information about this bulletin at provider.education@bcbssc.com or by calling 803-264-4730.

BlueCross® BlueShield® of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association.