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Pediatric billing for well visits, vaccines and screenings
Billing for pediatric practices: EPSDT well-child visits, developmental, behavioral screenings and more.
How pediatric billing works
Medicaid covers children through EPSDT, which sets a schedule of well-child visits and screenings. Each screening, such as developmental screening (96110) or behavioral assessment (96127), can be billed separately when performed with a standardized tool.
Codes we bill every day
| Code | What it covers |
|---|---|
| 99381–99385 | New patient preventive visits by age |
| 99391–99395 | Established patient preventive visits by age |
| 90460 / 90461 | Vaccine administration with counseling |
| 96110 | Developmental screening with a standardized tool |
| 96127 | Brief behavioral or emotional assessment |
| 99173 | Visual acuity screening |
Code descriptions are summarized. Payer coverage and documentation rules vary by plan and state.
Denials we prevent
- Newborn claims sent before the baby has coverage
- VFC vaccines billed with product charges
- Screenings billed without a standardized instrument
- EPSDT visits outside the periodicity schedule
- Sick visits on well days without modifier 25
FAQ
Questions about pediatric billing
How do you handle newborn billing?
We hold newborn claims until the baby is added to coverage, then bill with the correct member ID.
Free billing audit
Get a free pediatric billing audit
Send a few details and we will set up a short call to review your claims, denials and A/R. No cost and no commitment.
We sign a Business Associate Agreement before we handle any patient data.