The Challenge
Pediatric billing requires more than claim submission; it demands expertise in child-specific coding, age-based modifiers, and CMS/AMA reimbursement rules. Our pediatric billing company specializes in preventing denials and recovering lost revenue.
Our pediatric billing company supports practices across the U.S. with:
Challenges
| Challenge | Impact on Revenue |
|---|---|
| Age-Based Modifiers | Incorrect coding leads to denials |
| Preventive Care Reimbursements | Delays in vaccine & screening payments |
| Developmental Documentation | Missing data triggers denials |
| Family/Multi-Child Visits | Missed charges |
| Staffing Shortages | Reduced follow-ups |
| Immunization Bundling Errors | Major revenue loss from incorrect code usage (90460/90461 vs. 90471/90472) |
Fix Your Billing Gaps Before They Cost You More Revenue
Our pediatric billing experts identify hidden revenue leaks and correct them before claims are submitted.
Services
Our billing experts handle every aspect of pediatric revenue cycle management, from coding and claim submission to denial prevention and accounts receivable (A/R) recovery. Our pediatric medical billing services cover the full revenue cycle:
Eligibility & Benefits Verification
We verify coverage, prior authorization, and secondary insurance to prevent eligibility-based rejections.
Pediatric Coding & Charge Entry
Our experts accurately assign pediatric CPT codes and ICD-10 codes for age-based encounters, Modifier 25 scenarios (well-child + sick visits), and immunization billing pediatrics (90460/90461).
Well-Child Visit Billing Guidelines
Every preventive exam and developmental screening is billed using well-child visit billing best practices to ensure full reimbursement.
Newborn & Neonatal Billing Services
From delivery attendance (99460) to initial hospital care (99463), our newborn billing services ensure complete documentation and prevent denials.
Pediatric Telehealth Billing
We manage virtual encounters with accurate time-based codes and payer-specific telemedicine modifiers using pediatric telehealth billing expertise.
Immunization Administration Billing
Developmental Screening Billing
Adolescent Billing & Confidential Services
Confidential reproductive health, STI testing, and mental health services with appropriate insurance split. Includes preventive medicine code transition from 99381–99384 (pediatric) to 99385–99387 (adult).
CHIP & Medicaid EPSDT Billing
Coordination of Benefits for Dual-Covered Patients
Our Proven Process
Claim Scrubbing
AI-powered tools detect age-specific coding mismatches and documentation gaps before submission
Denial Management & Appeals
Accounts Receivable (A/R) Recovery
Payment Posting & Reconciliation
Choose Your Plan
Transparent Pricing with no hidden Cost
Starter
For Solo & Small Practices
of collections
Most Popular
Growth
For Group Practices & Clinics
of collections
Enterprise
Hospitals & Large Systems
Volume-based pricing
Our Expertise
50+ EHR/EMR/PMS
Subspecialties
Pediatric Cardiology
EKGs & echocardiograms denied for “non-medical necessity”
Pediatric Orthopedics
Pediatric Neurology
Pediatric Behavioral & Mental Health
HIPAA Compliance Made Simple, Privacy Guaranteed
Denial Codes
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.
| 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. |
KPIs
Collection Ratio
A/R Reduction
First-Pass Clean Claims
Denial Rate
Revenue Increase
Day A/R
Get The Answers You Need
A: Missing modifiers, incomplete documentation, incorrect ICD-10 linkages, and COB (Coordination of Benefits) errors are the leading causes of pediatric claim denials.
A: Document sick visit notes separately from well-child notes. We verify payer-specific requirements before submission.
Get Started
Pediatric billing expertise that keeps your revenue safe and your focus on care. If your pediatric practice is losing revenue to Modifier 25 denials, immunization bundling errors, or coordination of benefits issues, request a free pediatric billing audit. We review your last 30 claims and identify every recoverable dollar.
