Specialty
Pediatric Billing and Revenue Cycle Management
Well-child care. Vaccine administration. EPSDT schedules. Dual-purpose visits.
Why it’s different
Pediatric billing requires managing complex immunization coding, state VFC (Vaccines for Children) programs, and age-specific preventive care schedules.
Visits frequently combine routine well-child exams with acute illness management, requiring precise modifier 25 usage to capture full reimbursement.
Common challenges
Where the money goes missing.
- Vaccine Administration Coding
- Admin codes unbundled or miscoded, causing denied administration fees.
- Sick & Well Visit Combinations
- Modifier 25 omitted when addressing acute illness during an EPSDT preventive exam.
- VFC vs Commercial Vaccines
- Commercial vaccine codes billed for state VFC supply, causing immediate payer rejections.
- Developmental Screenings
- Developmental and behavioral screening codes left unbilled or unbundled.
How we help
We audit pediatric claims daily, ensuring accurate vaccine product and administration code pairing, proper modifier 25 application, and full capture of developmental screenings.
Our team monitors payer-specific pediatric policies to eliminate denials and protect practice cash flow.
Key codes
- CPT 99381–99394
- CPT 90460 / 90461
- CPT 96110
- Modifier 25
Indicative, not exhaustive. Code sets and payer policies change.
Get a Pediatric Billing Analysis
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