Maximize Revenue for
Pediatric Practices
From navigating well-child checks and complex vaccine administration coding to managing high Medicaid volumes, we protect your pediatric practice from costly denials and underpayments.
Preventive vs. Sick Visits
We ensure you get paid for both when a routine physical reveals an acute illness, applying modifiers flawlessly to prevent bundling denials.
Why Pediatric Billing Needs Specialists
Pediatric practices experience extremely high patient volumes with unique coding rules. Billing multiple vaccine components, differentiating between with/without counseling, and managing state-specific Medicaid rules require specialized knowledge. We streamline your billing so you never leave money on the exam table.
Vaccine Administration Mastery
Billing vaccines requires separate codes for the toxoid and the administration itself. We accurately bill 90460/90461 (with counseling) or 90471/90472 to maximize your reimbursement.
Preventive & Acute (Modifier 25)
When a child comes in for an annual physical but needs treatment for an ear infection, we perfectly apply Modifier 25 with distinct diagnosis codes to ensure both visits are paid.
VFC & Medicaid Compliance
Managing state-provided Vaccines for Children (VFC) requires specific SL modifiers and zero-dollar billing techniques. We ensure compliance so you never lose your administration fee.
Securing Revenue from
Check-In to Payment
We proactively manage the high-volume nature of pediatrics, ensuring every screening, immunization, and sick visit is coded accurately and paid promptly.
Patient Eligibility Checks
Pediatrics sees frequent insurance changes (like switching between CHIP and commercial). We run deep verifications before every visit to prevent back-end denials.
Developmental Screenings
We capture easily missed revenue by ensuring developmental screenings, vision tests, and hearing assessments (CPT 96110, etc.) are billed alongside preventive visits.
High-Speed Claim Scrubbing
Our system scrubs claims for age-appropriate preventative codes (e.g., 99391-99395) and ensures they strictly match the patient’s exact age in months and years.
Denial Management
Payers frequently bundle sick visits into well-child checks inappropriately. Our appeals team fights these denials using clinical notes to prove the acute service was distinct.
Stop Losing Revenue to
Bundling Denials
Partner with specialized billers who understand the exact mechanics of well-child checks, vaccine administration, and Medicaid compliance. Contact Valeria Healthcare Solutions today.