Pediatrics Billing That Pays What You Earn
Pediatric billing runs on tight margins: well-child visits dominate schedules, EPSDT screening requirements create documentation traps, and vaccine administration billing is under constant payer audit. Meanwhile, Medicaid — the dominant payer for most pediatric practices — has state-specific rules that differ from commercial billing in almost every dimension. 360Solutions provides billers who know EPSDT, know the 99381–99394 preventive series, and know how to capture all billable Medicaid services without triggering audits.
Where Pediatrics Practices Lose Revenue
These are the coding and billing pitfalls that cost pediatrics practices the most — and where our specialised billers add the most value.
EPSDT Screening Compliance
Medicaid's Early & Periodic Screening, Diagnostic, and Treatment mandate covers a broad set of screenings that must be billed correctly at each age milestone. Missing a required screening code means leaving Medicaid money on the table.
Vaccine Administration Billing
Vaccine administration codes (90460/90461 for counselling, 90471/90472 without) are frequently unbundled or miscoded. We verify the correct code for each antigen administered and the provider's role in counselling.
Medicaid State Rule Variations
Every state Medicaid program has different fee schedules, prior auth requirements, and covered services lists. We maintain state-specific rule sets and verify eligibility at every visit to catch coverage gaps before billing.
Developmental Screening Codes
Autism screening (96110), developmental/behavioral screening (96127), and depression screening (G0444) are frequently missed or bundled incorrectly. We bill all eligible screenings with correct modifiers and diagnoses.
High-Risk CPT Groups
Code ranges payers audit most aggressively in Pediatrics.
Common Denial Patterns
Knowing these before submission is the difference between a 60% and a 96% first-pass rate.
Well-child and sick visit billed same day without modifier -25
Vaccine administration code does not match counselling documentation
EPSDT screening billed with wrong age range code
Medicaid secondary not filed after primary commercial payer
Missing prior auth for referrals to specialists (managed care plans)
Send us your last 90 days of remittance data — we'll identify your top 3 fixable denial sources at no cost.
Request Free Audit →How 360Solutions Works for Pediatrics Practices
Free 2-Week Billing Audit
We review your last 90 days: denial breakdown by category, AR aging by payer, charge lag, collection rate, and any recurring coding issues specific to your specialty. No commitment required.
Specialty Coder Assignment
You are paired with a coder trained specifically in pediatrics coding. They learn your providers, your documentation patterns, and your payer mix before touching a claim.
Parallel Billing Transition
We run alongside your current billing for 10–14 days with zero cash flow disruption. Claims keep moving during the transition. Your account manager provides daily status updates.
Live KPI Dashboard
Real-time visibility into billed, paid, denied, AR aging, and collection rate — segmented by provider and payer. No black box, no month-end surprises.
Weekly Account Manager Call
Every week your dedicated account manager walks through last week's KPIs, denial trends, and any action items. Critical issues are escalated the same day — not at the next scheduled call.
Questions From Pediatrics Practices
Start With a Free,
No-Obligation Audit
Two weeks, no contract. A certified pediatrics billing specialist reviews your claims, denial patterns, and AR — and shows you exactly what is recoverable.