What is Pediatric Billing
Paediatric billing is the process of sending in claims for care given to kids. It includes babies, toddlers, and teens. To show what services they gave, doctors use codes. These codes have to be right. Mistakes can cause claims to be denied or payments to be lost.
Why billing for kids is hard
Kids need a different kind of care than adults. Their visits usually include:
- Checking their growth
- Giving them vaccines
- Screening them
- Taking care of them when they're sick
- Assessing their development
The rules for billing change a lot. There are strict rules for Medicaid and CHIP. Insurance companies want you to write down everything. Telehealth makes things more complicated. HIPAA rules keep kids’ information private. All of these rules must be followed by billing teams.
How ProMedCL Makes It Easy to Bill
ProMedCL is a medical billing company based in the U.S. They help paediatric clinics get their money faster. Their group knows the rules. They keep an eye on changes made by CMS and insurance companies. They look over every claim before sending it. They fix mistakes. They check on claims that haven’t been paid. They help clinics follow the rules
10 Important Paediatric Billing Codes
| Code | Description |
|---|---|
99381 |
New patient, less than a year old |
99382 |
New patient, 1 to 4 years old |
99383 |
New patient, between the ages of 5 and 11 |
99384 |
New patient, 12 to 17 years old |
99391 |
Established patient, less than a year old |
99392 |
Established patient, 1 to 4 years old |
90460 |
Vaccine administration with counselling (first vaccine) |
90461 |
Vaccine administration with counselling (each extra vaccine) |
Z00.129 |
Routine check-up for a child with no unusual results |
Z23 |
Meeting for vaccinations |
Changes to CMS for 2025
This year, CMS changed a lot. The rules for billing children are stricter.
Here’s what’s new:
• Rules for telehealth: You have to keep good records of virtual visits. You need to keep track of how much time you spend.
• E/M codes: Doctors can charge based on how long they work or what they decide.
• EPSDT services: Medicaid now wants more information in screenings.
• Rules for bundling: You have to bill some services together. CMS made changes to the edits.
• Changes to HIPAA: Parents can see records, but teens have different rules.
ProMedCL keeps track of these changes. They quickly update their system. Clinics don’t have to worry. “
Understanding the Problems and Solutions of Paediatric Billing
It’s not just about codes when it comes to paediatric billing. It’s important to know how kids are treated and what insurance companies think. Vaccines, screenings, and counselling may be part of each visit. You have to use the right codes and modifiers when you bill for these services. The claim could be denied if one detail is wrong. This is how a lot of clinics lose money.
It’s also important to follow HIPAA rules. Records of children are private. Teens have the right to privacy. Parents may or may not be able to see some records. Billing teams need to know the rules. The systems that ProMedCL uses are safe. They teach their staff about HIPAA. They also help with audits.
What Makes Billing for Kids Different
There are special rules for billing for kids. Kids grow up very quickly. They need different kinds of care at different times. That needs to be reflected in the bill.
A lot of paediatric care involves giving vaccines. There is a different billing code for each vaccine. Some also need codes for counselling. The clinic loses money if those are missed.
ProMedCL makes sure that every vaccine is charged correctly.
Another important area is developmental screenings. These help find delays early on. Insurance companies want proof that screenings were done. ProMedCL helps clinics keep accurate records of these. They connect the right codes for diagnoses. They also help with follow-up billing if you need to send someone else.
Making Your Practice Bigger with Better Billing
Clinics grow when they bill well. Quick payment of claims improves cash flow. Clinics can hire more people. They can do more things. They can buy better tools.
ProMedCL helps clinics get bigger. They cut down on denials. They make payments go faster. They send reports every month. They help with getting credentials. They help marketing by giving them information about billing.
Why ProMedCL is the Best Partner
ProMedCL is more than just a billing service. They work together. They know how to take care of kids. They keep up with CMS. They fix mistakes. They get back to you. They teach your employees. They help you follow the rules.
Their software is simple to use. Their reports are easy to understand. Their customer service is quick and friendly. They work with clinics of all sizes. ProMedCL can help you no matter how big or small your business is.
Are You Ready to Make Your Paediatric Billing Easier?
You can focus on your patients while ProMedCL takes care of the billing. They’ve got you covered with everything from vaccines to telehealth, Medicaid to audits.
Get in touch with ProMedCL today. Get paid sooner. Less stress. Expand your practice.