Certified AAPC and AHIMA coders trained in pediatric CPT and ICD-10 codes.
Real-time analytics to detect claim errors before submission.
Compliance driven processes to ensure every claim meets medical necessity and payer requirements.
Our 500+ certified billing experts handle every aspect of pediatric revenue cycle management (RCM), from coding and claim submission to denial prevention and accounts receivable (A/R) recovery. Our pediatric medical billing services in the USA cover the entire revenue cycle.
We verify coverage, prior authorization, and secondary insurance to prevent eligibility-based rejections.
Our experts accurately assign pediatric CPT codes and ICD-10 codes for age-based encounters, Modifier 25 scenarios (well-child + sick visits), and immunization coding for pediatrics (90460/90461).
Every preventive exam and developmental screening is billed in line with AAP and CMS standards to ensure full reimbursement.
From delivery attendance (99460) to initial hospital care (99463), we confirm complete documentation for newborn services to avoid denials.
We manage telehealth encounters using time-based coding rules and payer-specific telemedicine modifiers to achieve accurate reimbursement for virtual care.
AI-powered tools detect age-specific coding mismatches and documentation gaps before submission, maintaining a 95%+ clean claim rate.
Our pediatric claim denial management experts thoroughly analyze every denial, identify payer trends, and develop appeals that include the necessary clinical evidence.
Dedicated teams follow up on unpaid claims to maintain accounts receivable (A/R) and a denial rate.
All transactions are posted with complete visibility to ensure accuracy, compliance, and revenue integrity.
In today’s value-based care environment, billing compliance has a direct impact on your financial and regulatory health. Our pediatric billing experts ensure that every claim aligns with MIPS, MACRA, and Value-Based Care (VBC) requirements to safeguard your revenue and practice reputation.
We help your pediatric practice prevent CMS penalties, payer claw backs, and audit-triggering errors by:
Automated performance reporting for developmental and immunization benchmarks.
Automated performance reporting for developmental and immunization benchmarks.
Automated performance reporting for developmental and immunization benchmarks.
Incorrect codes delay or deny payments for visits
and procedures
Delayed payments for vaccines and screenings
Missing milestone notes cause non-compliance denials
Redundant entries and missed charges
Increased billing errors and reduced follow-ups
95%+
Clean Claims Rate
20–30
Days A/R
<4%
Denials
Pediatric billing denials often arise from coordination of benefits errors, age-specific coding mistakes, and modifier misuse. Our certified pediatric coders utilize real-time claim scrubbing, AI-driven error detection, and detailed audit trails to eliminate these issues before submission, maintaining a 95%+ clean claim rate, an A/R turnaround of 20-30 days, and a ≤4% denial rate across all pediatric practices we serve.
| Denial Code | Description |
|---|---|
| CO-50 | Service not covered under the patient's plan. |
| CO-197 | Preauthorization or precertification was not obtained. |
| CO-16 | Missing or incomplete claim or patient information. |
| CO-11 | Diagnosis does not match the billed procedure. |
| CO-29 | Claim submitted after the payer's timely filing deadline. |
| CO-22 | Coordination of benefits issues with multiple insurance providers. |
| CO-18 | Duplicate claim or service already processed. |
| CO-97 | Service included in another billed procedure (bundled). |
| CO-96 | Non-covered or excluded service under plan rules. |
| CO-109 | Claim not covered by this payer or coverage inactive. |
| CO-45 | Charges exceed the allowed fee schedule amount. |
| CO-170 | Patient deductible not met for this service. |
| CO-151 | Documentation is insufficient to support the billed service level. |
| CO-204 | Service not covered under the patient's benefit plan. |
| Common Issue: | EKGs or echocardiograms denied for “non-medical necessity.” |
| Solution: | We attach test results, link them to ICD-10 codes such as I51.7 or Q21.0, and follow the AAP/CMS coverage criteria. |
| Common Issue: | EEG time-based codes (95950–95967) rejected due to incomplete documentation. |
| Solution: | We audit notes, correct modifiers, and appeal with clinical progress evidence. |
| Common Issue: | Denials in imaging or fracture care due to missing documentation of the growth plate. |
| Solution: | We pair CPT 73560/73610 with ICD-10 injury codes (e.g., S89.91A) and attach radiology reports. |
FAQs Pediatric Medical Billing Simplified
Pediatric billing expertise that keeps your revenue safe and your focus on care. Our pediatric RCM platform delivers the efficiency of the best billing software, fully integrated, HIPAA-compliant, and trusted by pediatricians nationwide.
