Streamline Pediatric Billing and Maximize Your Reimbursements

Pediatric billing focuses on age-specific codes, growth monitoring visits, and immunization schedules that are unique to child healthcare. Unlike adult care, it requires knowledge of frequent wellness checks, modifier usage, and state vaccination programs.

Outsourcing to a pediatric billing company ensures accurate coding, compliance with payer policies, timely claims, and fewer denials. It saves time, reduces administrative burden, and improves revenue cycle performance.

Common CPT codes include 99381 to 99385 for new patient wellness visits, 99391 to 99395 for established patient checkups, and codes for vaccines like 90460 and 90461. Our experts ensure accurate code selection based on patient age and services provided.

We follow CDC and payer-specific immunization billing rules, including separate coding for administration and vaccine products. We also track VFC (Vaccines for Children) eligibility when applicable.

Yes. We integrate seamlessly with your pediatric EMR, such as PCC, eClinicalWorks, Kareo, or AdvancedMD, and follow your internal documentation workflow without disruptions.

Absolutely. We identify common denial trends such as incorrect modifier use or billing outside the covered age range and submit corrected claims or appeals to maximize reimbursement.

We apply correct coding for each vaccine and administration, including the use of add-on codes like 90461, and ensure all units and combinations are payer-compliant to avoid rejections.

We accurately apply age-related and procedure-specific modifiers such as 25, 59, and SL (for state-supplied vaccines), which are critical for correct payment and compliance.

Yes. We monitor payer-specific frequency limits on well-child visits and immunizations to prevent claim denials due to exceeding allowed services.

Yes. We specialize in pediatric Medicaid billing, including EPSDT (Early and Periodic Screening, Diagnostic, and Treatment) services, vaccine coverage, and state-specific requirements.

Most practices can onboard within 7 days. We conduct a quick discovery, align on workflows, integrate with your EMR, and begin processing claims efficiently.

Yes. Each client is assigned a dedicated account manager and a billing team trained specifically in pediatric coding and payer rules.

We run a full AR analysis, prioritize recoverable claims, and implement a structured follow-up process to recover unpaid pediatric claims within 30 to 90 days.

We deliver custom reports on claim status, denials, collections, vaccine revenue, visit utilization, and payer trends to give you full visibility into your practice’s financial health.