Pediatrics
Vaccine coding is a maze. Well-child intervals vary by payer. Nobody tells you that.
Pediatrics billing looks simple — until you look at the vaccine administration rules, the age-specific well-visit codes, and the payer-specific frequency limits. We've spent years inside pediatric billing. The difference shows in the first month.
Who this serves: Independent pediatric practices, multi-location pediatric groups, and pediatric departments inside multi-specialty practices.
Pediatric billing is deceptively complex. Every visit involves some combination of a well-child E&M, vaccine administration codes, vaccine product codes, developmental screenings, sick-visit overlays, and VFC program discipline. Any of those can go wrong individually — and often they compound.
Vaccine administration alone is its own mini-specialty. CPT 90460 (first component) and 90461 (additional components) need to be counted correctly. VFC-supplied vaccines are billed differently than purchased vaccines. Commercial payers each have their own rules about what they'll pay for alongside a well-visit.
Nisha has extensive pediatric billing experience. This is a specialty where generalist billers miss real revenue. We don't.
What separates a specialty-fluent biller from a generalist.
Well-child visits
- Preventive visit codes 99381–99385 (new) and 99391–99395 (established)
- Age-band discipline — payer frequency limits vary
- Same-day sick + well visits with modifier 25
- Developmental screenings (96110, 96127)
Vaccine administration
- 90460 + 90461 for each component counselled
- 90471–90474 for traditional administration
- VFC-supplied vaccines billed correctly
- Vaccine product codes separate from admin codes
Newborn care
- Newborn hospital visits (99460–99463)
- Normal newborn vs. sick newborn
- Circumcision when applicable (54150, 54160)
- Initial office visit post-discharge
Specialty pediatric
- ADHD evaluations and follow-up
- Asthma management visits
- Mental health integration billing
- Chronic condition coordination
Pediatric-fluent coders
We have staff who have coded pediatrics for years — the nuances are second nature.
Vaccine inventory discipline
VFC vs. purchased vaccine tracking isn't optional. We run it cleanly.
Same-day sick + well done right
Modifier 25 is where most pediatric practices leave revenue — or invite audit. We keep both risks in check.
Days 1–30 · Audit
Vaccine administration coding review. Well-visit frequency patterns checked by payer. Same-day sick+well patterns reviewed.
Days 31–60 · Take over
Submission and denial work transitions. Vaccine coding templates installed. Monthly packet.
Days 61–90 · Lift
Clean-claim rate at or above 96%. Vaccine admin revenue fully captured. Well-visit compliance on-track.
Ownership structure doesn’t change the billing mechanics. The practice is the unit we serve.
- Independent pediatric practices
- Multi-location pediatric groups
- Pediatric departments inside multi-specialty practices
- Practices expanding into adolescent medicine or behavioral health
Free audit
Curious how much you're leaving on the table in pediatrics?
Our free 30-day audit tells you — specific codes, specific payers, specific dollar amounts. No contract. You keep whatever we find.