Pediatric Billing & Coding
VFC vaccine programs, development screening, and complex preventative schedules managed cleanly.
Pediatric billing requires specialized focus on developmental screening, immunization registries, Vaccines for Children (VFC) administration, and well-child visit coding.
Pediatric clinics deal with massive volumes of preventative screenings and vaccinations. If your billing service doesn't understand state-specific Vaccines for Children (VFC) guidelines or developmental screening modifiers, you are leaving substantial amounts of money on the table.
Our pediatric billers have mastered the art of screening billing. Whether you are conducting ASQ developmental screens, M-CHAT autism screens, or behavioral assessments, we bill them with the appropriate unit counts and modifier configurations.
We work with pediatricians to handle complex multi-child families, split-insurance coverages, and rapid newborn enrollments, ensuring your billing processes are seamless, compliant, and highly profitable.
What you get
- VFC Vaccine Billing Specialists
- Accurate handling of state-funded Vaccines for Children (VFC) billing, using correct CPT codes and SL modifiers.
- Developmental Screening Capture
- Ensure screening CPT codes (96110, 96127, 96160) are captured and reimbursed separately from standard well-visits.
- Newborn Encounter Coding
- Rapid processing of newborn billing codes to prevent initial registration and enrollment delays.
How it works
- 1
Preventative Schedule Review
We verify well-child schedule timings align with Bright Futures guidelines to prevent timing-based claim rejections.
- 2
Immunization Modifier Check
VFC vaccine administration codes (90460/90461) are separated from state-supplied product codes.
- 3
Screening Charge Capture
Developmental, behavioral, and hearing/vision screenings are appended to the claim as separate billable line items.
- 4
Payer Adjudication
Claims are submitted electronically, and pediatric-specific denial rules are resolved within 24 hours.
Common questions
How do you bill for a well-child visit and a sick visit on the same day?
We append Modifier 25 to the sick E/M code, supported by separate, compliant clinical charting in the patient's EHR.
How do you handle vaccine administration codes?
We use pediatric CPT codes 90460 and 90461, tracking counseling by a qualified healthcare professional per vaccine component.
What is your approach to newborn billing?
We guide clinics in billing under the mother's insurance policy for the initial 30 days while facilitating rapid registration for their own policy.
See what your practice is leaving on the table.
Send us a recent aging report and denial summary. We will show you where the money is stuck and what it would take to collect it.