Specialty billing
Pediatrics billing
We code pediatrics to your payer rules, not a generic template, handling well-child visits, vaccine administration, screenings, and EPSDT the way each plan and state Medicaid program expects.
Where claims slip
Billing considerations for pediatrics
Common places pediatrics revenue leaks. We code each of these to your payer rules, not a one-size-fits-all template.
Well-child and sick visits on the same day need age-appropriate E&M coding and the right modifier to both get paid.
Vaccine administration codes stack by component and route, which gets complex with multiple vaccines in one visit.
EPSDT billing rules vary by state Medicaid program.
Developmental, vision, and hearing screenings are separately billable but frequently missed.
Consent and documentation requirements for minors affect what can be billed.
Representative codes
Codes we see in pediatrics
A few illustrative CPT and HCPCS examples, not an exhaustive or guaranteed list. We code from your documentation and each payer's current rules.
- 99381-99397
- Preventive medicine visits, age-based well-child checks
- 90471 / 90472
- Immunization administration, first and each additional
- 96110
- Developmental screening, with scoring and documentation
- 92551
- Hearing screening, pure tone, air only
- 99173
- Visual acuity screening
Illustrative examples for context only. Actual codes depend on documentation, setting, and payer rules, and code sets change over time.
How we help
How our services apply to pediatrics
The same accountable team handles the work behind your pediatrics claims. Here is where each service fits.
Common questions
Pediatrics billing, answered.
Do you handle vaccine administration coding?
Yes. We code administration by component and route so multi-vaccine visits stack correctly alongside the well-child visit.
Can you bill EPSDT for our Medicaid patients?
We bill EPSDT to your state Medicaid program's rules, which differ from one state to another, so the visit and any required screenings are coded the way that program expects.
Are developmental screenings separately billable?
Often yes. Where documentation supports it, we capture developmental, vision, and hearing screenings rather than letting them fold silently into the visit.
Ready to bill pediatrics the right way?
732-209-1487 · info@vertexmedicalbilling.com