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Pediatrics billing

Pediatric Billing Services

Well-child visits, vaccines, screenings and Medicaid make pediatric billing high-volume and detail-heavy. Specialist billers make sure every shot and screening is paid.

  • Preventive visits and same-day sick visits coded correctly
  • Vaccine administration and counseling codes on every shot
  • Medicaid, CHIP and VFC program rules handled

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97%
Clean-claim rate target
10–15%
Revenue often missed on vaccines & screenings
< 30
Days in A/R goal
Overview

What makes pediatric billing different

Pediatric practices see many patients a day with relatively low reimbursement per visit, so small errors multiply quickly. Preventive visits are coded by age and new or established status, and adding a sick visit on the same day requires modifier 25 and separate documentation.

Vaccines are a major revenue and cost center. Each injection needs an administration code, with counseling codes counted per component, plus the vaccine product code, or a Vaccines for Children (VFC) modifier when state-supplied vaccine is used. Developmental, behavioral, vision and hearing screenings are separately billable but often forgotten.

A large share of pediatric patients are covered by Medicaid or CHIP, with state-specific rules and managed-care plans. A pediatric billing partner verifies eligibility at every visit, captures each screening and vaccine component, and follows up on low-dollar claims that busy practices tend to write off.

Why it's hard

Common pediatrics billing challenges

01

Vaccine administration coding

Counseling codes 90460/90461 are counted per vaccine component and frequently under-billed.

02

VFC vs. private stock

State-supplied vaccines require different codes and modifiers than purchased stock.

03

Preventive plus sick visits

Same-day problem care needs modifier 25 and clear documentation.

04

Missed screenings

Developmental, depression, vision and hearing screenings are billable but often not captured.

05

Medicaid and CHIP complexity

State rules and managed-care plans vary and eligibility changes often.

06

Low-dollar claim follow-up

Small denied claims add up but are rarely worked in busy practices.

What's included

What a pediatrics billing partner should handle

  • Eligibility checks at every visit, including Medicaid
  • Preventive and sick visit coding by age
  • Vaccine and administration code capture
  • VFC modifier and inventory alignment
  • Developmental and behavioral screening billing
  • Newborn and hospital care billing
  • Denial management and low-dollar claim follow-up
  • Credentialing with Medicaid managed-care plans
  • Family statements and payment plans
  • Vaccine revenue and visit-mix reporting
Coding focus

Key codes in pediatrics billing

Code(s)What it covers
99381–99385Preventive medicine visits, new patients, by age group.
99391–99395Preventive medicine visits, established patients, by age group.
90460 / 90461Immunization administration with counseling, first component and each additional component.
96110Developmental screening with a standardized instrument.
96127Brief emotional or behavioral assessment, per instrument.
99460–99463Newborn care in hospital or birthing center.
SL modifierState-supplied vaccine, used by many Medicaid programs for VFC stock.

Code examples are for orientation only. Always code from the current CPT®, HCPCS and ICD-10-CM code sets and payer policies.

Vaccine inventory accuracy

Keep VFC and private vaccine inventories separate and make sure claims reflect the stock used. Mixing them is a compliance issue with state VFC programs.

How it works

Find the right billing partner in four steps

1

Share your goals

Tell us your specialty, monthly claim volume, EHR and the problems you want fixed, denials, slow A/R or staffing gaps.

2

Get a free audit

We review a sample of your claims and aging report to show where revenue is leaking and what a specialist could recover.

3

Compare vetted companies

Shortlist billers with proven pediatrics experience, transparent pricing and verified client reviews.

4

Onboard with confidence

Sign a BAA, connect your EHR and clearinghouse, and track clean-claim rate, days in A/R and collections from month one.

Compare

Top-rated medical billing companies

Billing companies listed on BillerFirms, ranked by client reviews. Ask each one about their pediatrics experience.

See all companies
5.0 5 reviews

Who We Are We are Prime Medical Billing Solutions, LLC, a results-driven medical billing and revenue cycle partner headquartered in Atlanta, Georgia. Since about 2015, we have operated with the belief that true value lies in partnering, rather than merely contracting, with providers to ensure personalized attention and peak revenue performance. Founded by seasoned billing professionals with 20+ years of combined expert experience, our home office in Atlanta supports both individual practices and larger provider groups. Our team is passionate about maximizing reimbursements and simplifying the billing journey step by step. What Services We Offer We provide a comprehensive suite of services designed to optimize every phase of the revenue cycle: Claims processing & billing management, including electronic, UB‑04, and HCFA‑1500 formats Accounts receivable and collections, focusing on paid-to...

Atlanta, Georgia
Founded 2015
Claims ProcessingDenial ManagementCredentialing (Payer & License)
No reviews yet

GreenSense Billing is a trusted leader in medical billing and revenue cycle management, providing comprehensive solutions tailored to the unique needs of healthcare providers across the United States. Our mission is to streamline administrative complexities, optimize reimbursements, and enhance financial performance, allowing medical professionals to focus on delivering exceptional patient care. Our Services • We offer end-to-end medical billing and revenue management solutions, including: •  Medical Billing & Coding - Accurate claims processing to maximize reimbursements and minimize denials. •  Revenue Cycle Management (RCM) - A holistic approach to managing claims, payments, and collections. •  Provider Credentialing - Seamless enrollment with insurance networks to ensure timely reimbursements. •  Financial Solutions - Data-driven insights and financial reporting to optimize practice...

Las Vegas, Nevada
Founded 2003
Claims ProcessingDenial ManagementRevenue Cycle Management
No reviews yet

Let’s face it, medical billing shouldn’t be the most challenging part of running a practice. At Medical Lean Management, we take the chaos out of revenue cycle management so you can get back to what matters: delivering excellent patient care. Based in Corona, California, we’re not just another faceless billing company, we’re your partners in efficiency, here to simplify the financial side of healthcare. Why Us? Because We Get It. Paperwork piles up. Claims get denied. Regulations keep changing. It’s enough to make anyone’s head spin. That’s where we step in. We don’t just process claims, we optimize your entire revenue cycle, cutting through the red tape to get you paid faster and with fewer headaches. Our goal? To make your billing so smooth, you’ll wonder how you ever managed without us. Here’s How We Help: ✔ Fewer Denials, More Revenue - Our precision-driven approach slashes claim den...

Corona, California
Founded 1994
Claims ProcessingDenial ManagementRevenue Cycle Management
No reviews yet

Overview & Mission Access Revenue Hawaii, founded in 2022 in Holualoa, Hawai‘i, is a specialized medical billing and revenue cycle management (RCM) company with a primary focus on behavioral and mental health providers. Drawing deeply from social work roots, the leadership team recognized the administrative friction mental health professionals face, credentialing delays, complex payer regulations, EMR documentation requirements, and chose to build a firm that helps clinicians focus fully on patient care. Their mission centers on removing financial and operational barriers so therapists, counselors, and behavioral health groups can thrive financially while delivering quality care to Hawai‘i’s communities. Origin Story & Local Presence The company was born out of a clear insight: behavioral health providers in Hawai‘i suffer unique administrative challenges. From intricate Medicaid billing...

Chandler, Arizona
Founded 2007
Claims ProcessingDenial ManagementRevenue Cycle Management
Pricing

How much does pediatrics billing cost?

Most billing companies charge a percentage of what they actually collect, so their incentive matches yours. Complex specialties sit at the higher end of the range because of prior authorizations, modifiers and appeal work.

Percentage of collections
5% - 8%

Most common. You pay only on money collected.

Per claim
$4 - $10

Predictable for high-volume, low-complexity claims.

Hourly / FTE
$12 - $35/hr

Dedicated billers working inside your systems.

Typical market ranges; actual quotes depend on claim volume, payer mix and scope. Compare quotes from several companies.

FAQ

Pediatrics billing FAQs

With 90460 for the first component of each vaccine when counseling is provided and 90461 for each additional component, plus the vaccine product code or VFC modifier.

Yes, when a significant problem is addressed and documented separately, using modifier 25 on the problem-oriented E/M.

Yes. Standardized developmental and behavioral screenings are billed separately with codes such as 96110 and 96127.

Yes, including state Medicaid, CHIP and Medicaid managed-care organizations.

Common reasons include eligibility changes, missing modifier 25, incorrect vaccine counseling units and VFC coding errors.

Typically 5% to 8% of collections.

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