Specialty Focus: Pediatrics

Pediatric Billing,
Engineered for Precision.

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Well-Child Care

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Well-Child
vaccines
Vaccines
sick
Acute Care
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Screenings

Select a pediatric focus area on the scanner or list below to reveal the specific CPTs, age-based modifiers, and documentation standards our certified coders master to secure your revenue.

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Well-Child Care & EPSDT

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Flawless coding for preventative medicine services (99381-99385, 99391-99395). We ensure Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) guidelines are met, capturing all age-appropriate sensory, vision, and hearing screenings seamlessly.

EPSDT / Preventative 99381-99395 Codes Modifier 25 Defense
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Immunizations & VFC

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Pediatric vaccine billing is notoriously complex. We accurately apply age-specific counseling codes (90460/90461) versus non-counseling administration codes (90471-90474). We also handle VFC (Vaccines for Children) state-specific modifiers (like SL) to prevent supply denials.

Counseling (90460) Component Counting VFC Modifiers (SL)
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Acute & Sick Visits

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Proper E&M leveling for high-volume acute care. We ensure diagnostic tests (strep, flu, RSV) and minor procedures (nebulizer treatments, laceration repairs, wart removals) are perfectly linked with medical necessity to avoid NCCI bundling.

E&M Leveling In-Office Labs Nebulizer Treatments
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Developmental Screenings

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Capturing vital early-intervention revenue. We accurately bill for developmental screenings (96110), autism screenings, and brief emotional/behavioral assessments (96127), ensuring they aren't inappropriately bundled into the standard well-child E&M code.

96110 (Developmental) 96127 (Behavioral) Screening Modifiers

Pediatric Billing is Complex.
We Make It Profitable.

Pediatric practices face unique high-volume challenges, from complex multi-vaccine administrations to aggressive bundling of sick and preventative visits. Hover over the challenges below to see how HBS secures your revenue.

Well-Child + Sick Visit

When a child comes in for an annual physical but also presents with an ear infection or acute asthma flare-up, payers routinely deny the secondary problem-oriented E&M code if billed incorrectly.
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The HBS Solution

We ensure distinct diagnosis mapping. By separating the preventative Z-codes from the acute ICD-10 codes and properly applying Modifier 25, we secure payment for both services legally.

Vaccine Component Errors

Billing multiple vaccines gets complicated fast. Missing counseling codes based on age, or misreporting multi-component vaccines (like MMRV) vs. single vaccines leads to immediate underpayments.
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The HBS Solution

Our automated cross-checks verify patient age, presence of counseling, and the exact serum CPT vs. administration CPTs, ensuring maximum component-level capture for every antigen administered.

Screening Form Bundling

Payers routinely try to bundle developmental screenings (96110) or maternal depression screenings (96161) into the global preventative visit, causing you to perform uncompensated work.
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The HBS Solution

We implement strict rules engines that recognize specific screening instruments (e.g., ASQ, M-CHAT). We append modifier 25 to the E&M and modifier 59 to the testing code if required by the specific commercial payer.

The HBS Pediatric Advantage

We don’t just process claims; we act as the financial safeguard for your practice. From capturing immunization incentives to eliminating E&M under-coding, we maximize your high-volume, pediatric revenue.

98% First-Pass Clean Claim Rate

Our proprietary scrubbing engine catches modifier 25 errors, missing vaccine counseling codes, and incomplete EPSDT criteria before the claim ever leaves our system.

48-Hour Turnaround

High patient volume requires speed. We guarantee that your daily encounters, from back-to-back well-child checks to winter flu seasons, are coded and billed within 48 hours.

VFC Program Compliance

State Vaccines for Children (VFC) programs are strict. We manage the SL modifiers and ensure you receive the maximum allowable administration fees without risking state audits.

Average Clinic Revenue Lift (First 6 Months)

M1
M2
M3
M4
M5
+16% Lift
M6
Calculate Your Specific ROI

Stop Pediatric Denials Today.

Let our specialized pediatric billing team audit your current processes. Discover exactly where your revenue is leaking on preventative care bundling and vaccine administration errors.