Pediatric Billing Services
Pediatric Billing Services That Keep Your Practice Financially Healthy
Pediatric billing carries challenges no other specialty faces: vaccine administration coding, government program rules, age-based code transitions, and Medicaid-heavy payer mixes that demand precision at every step. ProtoMed's certified pediatric billing specialists handle every claim correctly the first time. Fewer denials. Faster reimbursements. More revenue.
98%+
Clean Claim Rate
We review every claim before submission, catching vaccine bundling errors, age-code mismatches, VFC documentation gaps, and eligibility issues that trigger denials.
Why Choose ProtoMed
Stop Letting Pediatric Billing Complexity Drain Your Practice Revenue
Pediatric practices face billing challenges that are genuinely unique. No other specialty manages as many vaccine codes per patient, navigates as many government program rules simultaneously, or has to track age-based code transitions where a patient's 18th birthday silently invalidates every code that worked the day before. Add a Medicaid-heavy payer mix with its own documentation requirements and prior authorization rules, and the margin for error is significant.
ProtoMed's certified pediatric billing team understands every dimension of children's health billing: well-child visit coding, VFC and CHIP program compliance, EPSDT documentation, vaccine administration coding, and the age-stratified E/M codes that change as your patients grow. We submit clean claims, manage government program billing correctly, and follow up on every denial so your revenue cycle stays as healthy as your patients.
Certified Pediatric Billing Specialists
Every biller on your account holds active AAPC and AHIMA credentials with specialized training in pediatric CPT coding, vaccine administration codes, and government program billing requirements.
98%+ Clean Claim Rate
We review every claim before submission, catching vaccine bundling errors, age-code mismatches, VFC documentation gaps, and eligibility issues that trigger denials.
Zero-Friction Access
We securely log into your existing EHR, Epic, Athenahealth, eClinicalWorks, and more, with zero disruption to your clinical schedule or patient flow.
End-to-End Claims Management
From insurance verification and prior authorization to claim submission, denial resolution, and payment posting, we manage your complete pediatric billing cycle.
Proactive Denial Management
Every rejected claim is investigated, corrected, and resubmitted. We recover the pediatric revenue your practice is owed, including denied vaccine claims and Medicaid rejections.
Transparent Financial Reporting
Monthly reports and real-time billing data give you a clear picture of your collections, denial patterns, payer reimbursement rates, and overall revenue performance.
Pediatric Coding Expertise
Pediatric Coding Expertise That Reduces Denials
Pediatric billing spans well-child visits, vaccine administration, developmental screenings, behavioral health, and acute care, each with age-specific codes, program-specific documentation rules, and payer requirements that change as your patients grow. Our certified coders know every code and rule.
CPT 99381-99385
Well-Child Visits: New Patients
Age-stratified from infant through adolescent, each requiring the correct preventive E/M code for the patient's age at time of service.
CPT 99391-99395
Well-Child Visits: Established Patients
Age-stratified with preventive E/M codes, billed correctly for returning patients across every developmental stage.
CPT 90460-90474
Vaccine Administration
With counseling (under 18) and without counseling, per component. The highest-volume and most error-prone coding task in pediatric billing.
CPT 96110-96127
Developmental & Behavioral Screening
Standardized instruments with interpretation, including ADHD evaluations and developmental milestone screenings correctly coded and billed.
CPT 99202-99215
Sick Visit E/M
New and established patients, age-appropriate with MDM and time-based options. Correctly paired with well-visit codes using modifier -25 when applicable.
EPSDT / T1015
EPSDT & Medicaid Preventive Services
Comprehensive child health screening documentation with correct Medicaid-specific codes and program compliance requirements met at every encounter.
CPT 99401-99404
Preventive Counseling
Anticipatory guidance and risk factor reduction by age group, a billable service that many pediatric practices undercode or omit entirely.
Specialized Services
Specialized Billing for Every Pediatric Service
Pediatric billing demands accurate coding across well visits, immunizations, developmental screenings, sick care, and government programs, each with distinct rules that change as your patients age. ProtoMed's certified team handles every service type correctly.
Well-Child Visit Billing
Well-child visits are the revenue backbone of every pediatric practice, but age-stratified codes, same-day sick visit billing with modifier -25, and payer-specific preventive coverage rules create consistent denial risk. We apply the correct age-based CPT codes for every well-child encounter and ensure that same-day problem-focused services are billed separately and compliantly.
Vaccine Administration Billing
Vaccine billing is the most volume-intensive coding task in pediatrics. Each immunization requires the correct vaccine product code plus the appropriate administration code, with counseling (CPT 90460) for patients under 18, billed per vaccine component. We accurately code every immunization encounter and manage VFC documentation separately from privately billed vaccines to prevent program compliance issues.
Government Program Billing (VFC, CHIP, EPSDT)
VFC, CHIP, and EPSDT programs each have their own documentation requirements, billing rules, and reporting obligations that are entirely separate from private insurance billing. One error in program documentation can trigger audits or lost reimbursement. We manage all government program billing with the correct codes, documentation, and compliance processes, keeping your practice audit-ready at all times.
Developmental & Behavioral Screening Billing
Developmental screenings, ADHD evaluations, and behavioral health assessments are billable services that many pediatric practices undercode or miss entirely. We accurately bill standardized screening instruments using the correct CPT codes, manage prior authorizations for ADHD and behavioral evaluations, and ensure every screening encounter generates the reimbursement it deserves.
Age-Based Code Transition Management
When a patient turns 18, every pediatric code that applied the day before becomes invalid: well-child codes, vaccine administration codes, and age-specific modifiers all change. Missing a birthday transition is one of the most common and preventable denial sources in pediatrics. We track age-based code transitions across your patient panel so your practice never loses revenue to an avoidable coding switch.
Sick Visit & Acute Care Billing
Pediatric sick visits coded on the same day as well-child exams require precise modifier -25 application to bill both services. Urgent or acute care visits involving minor procedures, laceration repairs, nebulizer treatments, ear irrigations, must be coded with the correct pediatric procedure codes and accompanying E/M documentation. We handle every sick and acute encounter with the same accuracy we apply to preventive visits.
Our Process
How ProtoMed's Pediatric Billing Process Works
A structured four-step process that keeps your revenue cycle as consistent as your patient schedule: from well-child seasons to flu shot weeks and everything in between.
Practice Audit & Onboarding
We review your current pediatric billing setup, identify revenue leaks from undercoded well visits, missed vaccine administration codes, and unresolved government program claims, then securely access your existing EHR with zero disruption to your patient schedule.
Eligibility Verification & Coverage Confirmation
Before each appointment, we verify patient insurance coverage, confirm Medicaid or CHIP eligibility, identify VFC program status, and flag any prior authorization requirements for developmental evaluations or behavioral health services. Catching coverage gaps before the visit eliminates the most preventable source of pediatric claim denials.
Claim Submission & Payer Follow-Up
Clean, payer-compliant pediatric claims are submitted electronically on time to commercial insurance, Medicaid, CHIP, and Medicare. We track every claim, follow up persistently with payers, and appeal every denial, including vaccine coding rejections, age-code disputes, and government program documentation issues.
Payment Posting & Revenue Reporting
Payments are posted accurately, patient balances are billed promptly, and you receive clear monthly reports tracking your collections, denial patterns, vaccine billing performance, and overall revenue by payer and service type.
Ready to Keep Your Pediatric Practice Financially as Healthy as Your Patients?
Let ProtoMed's certified pediatric billing specialists handle your complete revenue cycle: from well-child visit coding and vaccine billing to government program compliance and denial appeals. We'll audit your current billing, identify what's being missed, and start recovering it.
Get your free pediatric billing audit today. A ProtoMed expert will reach out within 24 hours.