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Pediatric Medical Billing: Well Visits, Vaccines and Medicaid Done Right
Preventive Care, Immunizations and Developmental Screening
Pediatric practices bill a high volume of well-child visits and vaccines, often to Medicaid and CHIP plans with their own rules. Missed vaccine administration codes and screening services add up quickly. Billing Care Assistant handles pediatric billing so preventive care, immunizations and sick visits are all paid correctly.
Common Pediatric Billing Problems We Fix
| Billing problem | Why it costs you | How we fix it |
|---|---|---|
| Vaccine administration under-billed | Codes 90460 and 90461 pay per vaccine component when the provider counsels the family | We count components and bill counseling codes when documented |
| VFC vaccines billed like purchased stock | Vaccines for Children doses are free to the practice, so only administration is billed | We bill VFC doses the way your state Medicaid program requires |
| Well and sick visit on the same day | The sick visit needs modifier 25 and its own documentation | We bill both visits when the record supports it |
| Screenings left off the claim | Developmental, vision, hearing and depression screenings have separate codes | We capture every screening done during the visit |
| Medicaid eligibility changes | Children move between Medicaid, CHIP and private plans often | We check eligibility before every visit |
Pediatric Codes We Handle
From newborns to teens
We code newborn care (99460-99463), preventive visits by age (99381-99395), sick visits (99202-99215), vaccine administration with counseling (90460-90461) or without (90471-90474), developmental screening (96110), behavioral and emotional assessments, vision and hearing screens, fluoride varnish, and point-of-care lab tests with their CLIA requirements.
How We Keep Pediatric Claims Clean
Accurate claims for busy offices
We verify Medicaid, CHIP and commercial coverage before visits, match vaccine and screening codes to the visit note, and scrub claims for payer edits before they go out. Denials go to our denial management team, and new pediatricians are enrolled with Medicaid and commercial plans through our credentialing services.
Payer Rules Pediatric Practices Should Watch
Medicaid and EPSDT
Medicaid's Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit sets the schedule of well-child visits and screenings, and many states have their own billing rules for these visits and for Vaccines for Children doses. Commercial plans usually follow the Bright Futures schedule for preventive coverage. We follow your state and payer rules so visits and vaccines are paid.
Why Pediatric Practices Choose Billing Care Assistant
A team that knows pediatrics
You get billers who understand vaccines and well-child care, close follow-up on Medicaid and commercial claims, and monthly reports by provider and payer. Want to see where your practice is losing revenue? Start with a free medical billing audit, or see all the specialties we bill for.
Pediatric Billing FAQs
What is the difference between 90460 and 90471?
Code 90460 is used for patients 18 and under when the physician or other qualified provider counsels the family about the vaccine. It is billed per vaccine, with 90461 for each additional component. Code 90471 is used when that counseling requirement is not met.
How are Vaccines for Children doses billed?
The practice does not pay for VFC vaccines, so it does not bill for the vaccine itself. It bills the administration, following the state Medicaid program’s rules for codes and modifiers.
Can a well visit and a sick visit be billed together?
Yes, when a significant problem is evaluated during the well visit. The sick visit is billed with modifier 25 and needs documentation separate from the preventive service.
Do you bill developmental and behavioral screenings?
Yes. Standardized developmental screening, depression screening and other assessments have their own codes, and we make sure they are billed whenever they are performed and documented.
Not Sure Where Your Revenue Is Leaking?
Get a free, no-obligation medical billing audit. We review your claims, denials and A/R, then show you what to fix first.
