Pediatrics Billing

Pediatrics runs on volume and prevention: well-child visits coded by age, vaccines with their own administration logic, and Medicaid rules that reward completeness. Elite Bill Care's pediatrics billing is tuned to that rhythm.

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Pediatrics billing specifics

• Preventive visits by age — 99381–99395 selected by new/established status and the child's exact age at the visit; same-day problem-oriented E/M added with modifier 25 only when the work is genuinely separate and documented.
• Vaccine administration — 90460–90474 with the counseling component rules, vaccine product codes, and state registry/VFC program considerations for Medicaid-eligible children.
• Screenings — developmental screening (96110), autism screening at the recommended ages, depression screening for adolescents, each with payer-specific coverage.
• Medicaid and EPSDT — well-child periodicity schedules and EPSDT requirements differ by state; claims aligned to your state's schedule (see your state on our coverage page).
• Newborn and hospital care — nursery and NICU-adjacent coding for groups that attend deliveries, with correct initial/subsequent day logic.

How we run it

High daily volume is handled with same-day charge entry reconciled against the schedule (no missed well visits), eligibility verified for coverage changes common with family plans, and vaccine units/products reconciled so product cost is never silently unbilled. Denials route through denial management; see the full picture on our billing services page.

Frequently asked questions