What we handle for pediatrics practices
Billers are assigned by specialty, so the person working your claims already knows your codes and your payers.
Well-child visits
Preventive visits (99381-99395) coded to the correct age band and new-versus-established status.
Immunisation administration
90460 and 90461 billed per component with the counselling requirement documented, and VFC vaccines billed correctly against state-supplied stock.
Developmental screening
96110 and 96127 billed alongside preventive visits where payers allow it.
Sick visit on a well day
Modifier 25 applied when a separate problem is genuinely addressed at a well-child visit.
Where pediatrics claims usually go wrong
These are the four issues we see most often when we take over a pediatrics practice.
Vaccine administration undercoding
90460 is per component, not per vaccine. A combination vaccine can carry multiple units. Practices routinely bill one unit and lose the rest.
VFC versus private stock
State-supplied vaccine cannot be billed as if you purchased it. Mixing the two triggers audits.
Age-band mismatches
Billing 99392 for a child who has aged into the next band is a clean rejection every time.
Modifier 25 overuse and underuse
Both cause problems. We apply it only where the note supports a separately identifiable service.
How we work
Eligibility, every day
Every next-day scheduled patient is verified for active coverage before the visit.
Charges validated
Codes and documentation are checked after the note is signed, before the claim is submitted.
Denials appealed
Every denial is reviewed, corrected and resubmitted. Nothing is written off by default.
Monthly reporting
Paid claims and AR aging reports so you can see exactly where your money is.
Pediatrics billing questions
Something not covered here? Call (833) 305-5528.
Do you handle VFC billing?
Yes. We bill the administration fee correctly for state-supplied vaccine and keep it separate from privately purchased stock.
Can you bill for developmental and behavioural screening?
Yes, where the payer covers it. We check payer policy rather than assuming.
What about newborn hospital visits?
We bill initial and subsequent newborn care including the correct discharge day management codes.