Specialty Billing
Pediatric Billing Services
Specialized billing for well-child care, developmental screenings, immunizations, and the full scope of pediatric practice.
Pediatrics Billing Overview
Pediatric billing has its own unique rhythm — high volumes of well-child visits, complex immunization administration billing, developmental and behavioral health screenings, and the added complexity of Medicaid as a primary payer for many pediatric practices. At 2 Lee's Billing, our team understands the nuances of pediatric coding from EPSDT (Early and Periodic Screening, Diagnostic and Treatment) requirements to same-day sick visit billing alongside well-child exams. We ensure your practice captures every billable service — from vaccine administration to lactation counseling — and submits clean claims that get paid the first time.
Coding Highlights
- ✓Well-child visit codes (99381–99385 / 99391–99395)
- ✓Immunization administration codes (90460–90461, 90471–90474)
- ✓EPSDT screening (Medicaid-specific billing requirements)
- ✓Developmental screening codes — 96110, 96127
- ✓Hearing and vision screening with separate billing
- ✓Modifier 25 for same-day sick + well visits
- ✓Lactation counseling — 99401–99404
Common Pediatrics Billing Challenges
Immunization Billing Complexity
Vaccine administration coding depends on the number of vaccines, patient age, and payer type. Incorrect administration code selection or bundling errors are common sources of denial.
Medicaid Payer Rules
Many pediatric practices have a high Medicaid patient mix. Medicaid billing requirements vary by state and plan, including EPSDT documentation and managed care plan-specific rules.
Same-Day Well and Sick Visit Billing
Billing a preventive visit and a problem-focused E/M on the same day requires modifier 25 and careful documentation. Errors here lead to claim denials and patient balance confusion.
Developmental Screening Codes
Screening tools like M-CHAT, ASQ, and CRAFFT generate separately billable codes that are often missed or bundled incorrectly with the E/M service.
Parental Counseling & Care Coordination
Anticipatory guidance, lactation support, and care coordination services are billable but frequently undercoded or omitted entirely from the claim.
Frequent Payer Policy Changes
Medicaid managed care plans and commercial payers regularly update their pediatric billing policies — keeping up requires ongoing monitoring and staff education.
How 2 Lee's Billing Supports Pediatrics Practices
Accurate Well-Child & E/M Coding
We correctly code preventive visits, sick visits, and same-day combined visits — including proper modifier use and documentation review.
Immunization Administration Billing
Every vaccine administered is coded and billed correctly — including administration fees, counseling add-ons, and appropriate payer-specific rules.
Developmental Screening Capture
We ensure developmental and behavioral health screening codes are captured and billed separately when documentation supports it.
Medicaid & CHIP Expertise
We have deep experience with state Medicaid and CHIP billing requirements — ensuring your EPSDT claims and managed care submissions are compliant and complete.
Eligibility Verification
We verify patient coverage before every visit — critical in pediatrics where coverage changes frequently as children age and family circumstances shift.
Denial Management
Every denied claim is reviewed and appealed promptly. We track pediatric-specific denial patterns and address root causes to improve first-pass acceptance.
Pediatrics Billing FAQs
Pediatric Billing That Captures Every Service
From well-child visits to complex immunization coding — our team knows pediatrics. Schedule your free consultation.
Or call us: (702) 478-8115 · Toll Free: (800) 364-1801