Pediatric Billing Services
RevClinic360 offers specialized pediatric billing services designed for the unique needs of children's health practices. Our certified coders are experts in well-child visit coding (99381-99395), immunization administration and vaccine product billing, developmental and behavioral screening documentation, newborn care and NICU coding, and Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services under Medicaid. We understand the age-specific guidelines that drive pediatric billing accuracy.
Pediatric practices face distinctive billing challenges including a high percentage of Medicaid patients, complex vaccine billing with Vaccines for Children (VFC) program requirements, and unique age-dependent coding rules for screenings, developmental assessments, and preventive services. Our team ensures accurate coding for every encounter — from routine well-child checks and school physicals to acute sick visits, behavioral health screenings, and management of chronic childhood conditions like asthma, ADHD, and diabetes. We also handle the special billing requirements for newborn care, circumcisions, and hospitalized pediatric patients.
- Well-child visit coding (99381-99395) with age-appropriate screening capture and parent counseling documentation.
- Vaccine billing expertise including VFC program compliance, administration codes, and product code accuracy.
- EPSDT/Medicaid billing with complete screening component documentation and proper referral tracking.
Our pediatric billing team identifies and captures commonly missed revenue including developmental screening codes (96110, 96127), maternal depression screening, fluoride varnish application, vision and hearing screenings, and BMI counseling. We also ensure proper billing for after-hours and weekend visits common in pediatrics, telephone/e-visit encounters, and care coordination for children with special healthcare needs. With pediatric practices increasingly relying on Medicaid reimbursement, our expertise in state-specific Medicaid rules is essential to your financial health.
Frequently Asked Questions
We manage the VFC program requirements including proper identification of VFC-eligible patients, billing only the administration fee (not the vaccine product) for VFC vaccines, and ensuring correct vaccine product code billing for privately insured patients.
Yes. We capture all billable developmental and behavioral screenings including autism screening (96110), developmental surveillance, social-emotional screening (96127), maternal depression screening, and adolescent screening tools — services that many practices provide but fail to bill.
We are experts in state-specific Medicaid billing rules, EPSDT requirements, and the various Medicaid managed care plan requirements. We ensure proper eligibility verification, authorization when required, and timely claim submission for maximum reimbursement.
Absolutely. We handle initial newborn care (99460-99463), subsequent hospital care, circumcision coding, newborn screening test billing, and the transition from hospital to outpatient pediatric care. We also manage the complex billing when the mother and baby have different insurance plans.
We code for behavioral health services commonly provided in pediatric settings including ADHD assessment and management, behavioral screening tools, brief emotional/behavioral assessments, and coordination with behavioral health specialists for integrated care models.