Pediatric Practices
Clean Claim Rate
Revenue Recovered
Claim Submission
Pediatric billing follows a rhythm unlike any other specialty. Well-child visits dominate the schedule, vaccine administration billing generates revenue that most practices undercount, and Medicaid represents a larger share of the payer mix than in adult medicine. Each of these areas has rules that differ from standard medical billing.
We build pediatric billing workflows around the unique patterns of your practice. From newborn care coding to adolescent preventive visits, our team ensures that every billable service is captured and submitted correctly to the right payer.
Every Pediatrics billing team deals with payer delays, coding nuance, and collection leakage. We tighten those weak points before they turn into write-offs.
Each vaccine injection involves two charges: the product code (90670, 90707, etc.) and the administration code (90460, 90461 for counseling-based, or 90471-90474). Practices that bill only the product code lose $15 to $30 per injection.
Pediatric practices often derive 40% to 60% of revenue from Medicaid. State-specific rules for covered services, reimbursement rates, and EPSDT screening requirements add layers of complexity that commercial-only billers miss.
When a well-child visit (99381-99395) also involves a new problem, both codes can be billed with modifier 25. But documentation must clearly separate the preventive and problem-oriented components.
Newborn care codes (99460-99463) cover initial and subsequent hospital care. Attendance at delivery (99464) and resuscitation (99465) are additional billable services that are frequently missed.
Support spans the full revenue cycle, from front-end verification to denial recovery and reporting.
Vaccine product and administration code billing optimization
Medicaid and CHIP billing with state-specific rules
Well-child visit coding (99381-99395) with modifier 25 management
Newborn care and hospital nursery billing
EPSDT screening documentation and billing compliance
Developmental screening and behavioral health integration billing
We support independent practices, multisite groups, and growing provider organizations with flexible workflows.
Independent physician groups
Multi-location practices
Private equity backed platforms
Hospital-owned outpatient groups
Pediatric billing follows a rhythm unlike any other specialty. Well-child visits dominate the schedule, vaccine administration billing generates revenue that most practices undercount, and Medicaid represents a larger share of the payer mix than in adult medicine. Each of these areas has rules that differ from standard medical billing.
We build pediatric billing workflows around the unique patterns of your practice. From newborn care coding to adolescent preventive visits, our team ensures that every billable service is captured and submitted correctly to the right payer.
Answers to the questions practice owners and managers ask most often before switching billing partners.
Practices that do not bill vaccine administration codes separately lose $15 to $30 per injection. For a practice administering 50 vaccines per week, that totals $39,000 to $78,000 in lost revenue annually. We audit vaccine billing monthly to prevent these losses.
Yes. Medicaid is a primary payer for most pediatric practices, and we manage state-specific rules including EPSDT requirements, VFC program documentation, and Medicaid managed care plan variations. We submit claims to the correct Medicaid plan and track reimbursement against the state fee schedule.
We bill the well-child preventive code and the appropriate E/M code with modifier 25 when documentation supports both services. The key is clear separation in the medical record between the preventive screening components and the problem-oriented evaluation.
Yes. Vaccines For Children (VFC) program rules prohibit billing Medicaid patients for VFC-supplied vaccines but allow billing the administration fee. We ensure your practice complies with VFC requirements while capturing all allowable administration revenue.
The most commonly missed codes are attendance at delivery (99464), initial newborn resuscitation (99465), and subsequent hospital care days (99462-99463). We review nursery logs to ensure every billable service is captured.
We manage the transition by updating insurance information, switching from pediatric to adult preventive codes at the appropriate age, and coordinating with the receiving adult practice to prevent claim overlaps during the transition period.
The difference is operational discipline. We focus on clean submissions, fast follow-up, and transparency.
Get a revenue review and a clear action plan tailored to your practice, payers, and claim mix.