Specialty
Pediatrics Medical Billing
Vaccine administration, well-and-sick visits, and a state programme that changes what you can bill.
What makes pediatrics billing different
Pediatric revenue concentrates in two places: well-child visits and immunisations. Both have coding structures that are easy to get subtly wrong in ways that persist for years, because nothing denies — the claim simply pays less than it should.
Vaccine administration is the clearest example. Counselling-based administration codes pay more than the standard set and apply to a large share of pediatric encounters, but only when counselling is documented and the patient meets the age criterion.
Administration code family
90460 and 90461 apply with documented counselling for patients through age 18. Defaulting the whole schedule to 90471 and 90472 costs money on nearly every well visit.
Component counting on combination vaccines
Each additional component of a combination vaccine is separately reportable. Practices routinely bill one unit for a multi-component product.
Vaccines for Children programme
State-supplied vaccine cannot be billed as product, only as administration. Billing the product creates a recoupment.
Sick and well on the same day
A significant separate problem addressed during a well visit is billable with modifier 25, and is frequently absorbed into the preventive visit instead.
Ask any billing company this
“What percentage of my vaccine administrations went out as 90460?”
A company that bills your specialty properly will answer this in one sentence. A company that treats every specialty the same will answer it with a brochure.A note on accuracy. Coding rules, coverage policies and payer edits change continually, and the specifics above reflect general practice rather than any individual payer contract or local coverage determination. Treat this page as a map of where to look, not as coding advice for a particular claim.