Get paid for every well-child visit, vaccine, and screening. Pediatric medical billing services built for high-volume, Medicaid-heavy pediatric practices.
Nevada Medical Billing provides pediatrics billing services for pediatricians, pediatric nurse practitioners, and multi-provider pediatric groups across Nevada. We capture the revenue pediatric practices most often miss: well-child visits billed to the periodicity schedule, sick and well visits on the same day, vaccine administration and Vaccines for Children (VFC) claims, developmental and behavioral screenings, newborn care, and chronic condition follow-up. We bill Nevada Medicaid, Nevada Check Up, all five Medicaid managed care plans, TRICARE, and commercial payers, and we sort out the coordination-of-benefits problems that come with family coverage.
HIPAA compliant · No obligation
Share a few details and a pediatric billing specialist will review your vaccine, screening, and visit coding with you.
95%+
clean claims target
<35
days in A/R target
VFC
and private-stock vaccines billed correctly
5/5
Nevada Medicaid MCOs billed
Pediatric billing is different because a single well-child visit can carry ten or more billable lines: an age-specific preventive code, a separate sick visit, several vaccine products, an administration code for each vaccine component, and screenings for development, vision, hearing, lead, or maternal depression. Each line has its own coding rule, and payers treat them differently. Many pediatric patients are covered by Nevada Medicaid or Nevada Check Up, where state-supplied vaccines can't be billed at all, while privately purchased vaccines are a practice's largest expense.
The patient is also never the subscriber. Claims depend on a parent's policy, the right relationship code, newborn enrollment timing, and which parent's plan pays first.
When a provider counsels on a combination vaccine, 90460 covers the first component and 90461 each additional one. Billing one administration per shot, or using 90471 when 90460 applies, can underpay every vaccine visit.
Vaccines are the biggest cost in a pediatric practice. When payers reimburse below purchase cost, or claims go out without NDCs, the practice loses money on every dose.
When a child comes in for a checkup and has an ear infection, both visits can often be billed. Without a separate, documented problem-focused service and modifier 25, the sick visit is lost.
Developmental screening, behavioral and maternal depression screening, vision, hearing, and lab screenings are separately billable for many payers. Practices that don't capture them lose small amounts on almost every well visit, which adds up fast.
Newborn claims filed under the wrong ID, the wrong "relationship to subscriber," or the wrong parent's plan are denied, often after the filing window has started running.
Flu and RSV season can double sick-visit volume. When billing staff fall behind, claims age and denials pile up just as cash flow matters most.
Healthy Kids (EPSDT): Nevada Medicaid covers well-child visits, screenings, and follow-up care for children under Medicaid Services Manual Chapter 1500, Healthy Kids Program.
Vaccines for Children (VFC): Nevada Medicaid and Nevada Check Up don't reimburse VFC vaccine products. They're billed at a zero rate or with modifier SL, and the administration is billed with the appropriate CPT code.
NDCs on every vaccine: Nevada Medicaid and Nevada Check Up require National Drug Codes on all vaccine claims.
Nevada Check Up is billed like Medicaid: Nevada's Children's Health Insurance Program (Title XXI) follows the same vaccine billing rules as regular Medicaid (Title XIX).
Other insurance: when a VFC-eligible child has other coverage, Nevada Medicaid lets providers bill the vaccine administration directly without first getting a denial from the other plan.
VFC enrollment runs through the Nevada Division of Public and Behavioral Health's immunization program.
Managed care everywhere: since January 2026, most Nevada Medicaid and Check Up children are enrolled in one of five MCOs (Anthem, CareSource, Health Plan of Nevada, Molina, SilverSummit), each with its own claim edits.
Preventive codes change with the child's age and whether they're new or established. Most payers, including Nevada Medicaid's Healthy Kids program, follow the Bright Futures/AAP periodicity schedule for how often well visits are covered.
| Age | New patient | Established patient |
|---|---|---|
Under 1 year | 99381 | 99391 |
1–4 years | 99382 | 99392 |
5–11 years | 99383 | 99393 |
12–17 years | 99384 | 99394 |
18–39 years (young adults still seen by pediatrics) | 99385 | 99395 |
Diagnosis: Z00.121 (with abnormal findings) or Z00.129 (without). Sports and school physicals are often not covered by insurance; we confirm coverage and set up self-pay pricing so they're not written off.
One encounter · separately supported claim lines
Age-appropriate preventive code
Check the periodicity schedule and visit documentation.
Problem-oriented E/M · modifier 25
Only when a significant, separately documented evaluation supports it.
Product · administration · screening
Review stock type, components, NDCs and each payer's coverage.
When a problem is significant enough to need its own evaluation, it's billed as a separate problem-oriented E/M with modifier 25. A minor problem handled within the checkup is part of the preventive visit. We check the documentation before adding modifier 25, rather than adding it to every same-day visit.
Losing sick visits inside checkups? Get a Free Pediatric Billing Audit and we'll review a sample of your well visits.
HIPAA compliant · No obligation
| Service | Codes | What we get right |
|---|---|---|
Administration with counseling (through age 18) | 90460 (first component), 90461 (each additional component) | Components counted for combination vaccines; physician or QHP counseling documented |
Administration without counseling | 90471–90474 | Used when 90460/90461 requirements aren't met |
COVID-19 vaccine administration | 90480 | Payer-specific product codes |
RSV monoclonal antibody administration | 96380 (with counseling), 96381 (without) | Product code and NDC on the claim |
Immunization counseling, no vaccine given that day (new in 2026) | 90482 (3–10 min), 90483 (11–20 min), 90484 (over 20 min); diagnosis Z71.85 | Billed once per date by total counseling time; not paid by Medicare and coverage varies by plan, so we verify payers first |
Vaccine products | Vaccine CPT codes with NDC; modifier SL or zero charge for VFC stock | VFC and private stock never mixed on a claim |
Vaccine recommendations and payer coverage have changed several times in 2025–2026. We confirm each payer's current coverage for each vaccine, so private-stock doses aren't given to children whose plans won't pay for them.
| Screening | Common codes | Note |
|---|---|---|
Developmental screening (such as ASQ, M-CHAT) | 96110 | Billed per standardized instrument, per payer limits |
Behavioral or emotional assessment (such as PHQ-A, ADHD scales) | 96127 | Per instrument |
Maternal depression screening at infant visits | 96161 | Caregiver-focused screening billed on the child's claim |
Vision screening | 99173 (acuity), 99177 (instrument-based) | Some payers bundle into the preventive visit |
Hearing screening | 92551, 92552 | Some payers bundle into the preventive visit |
Lead and anemia screening | 83655, 85018 | Lab or point-of-care |
Fluoride varnish | 99188 | Covered by many Medicaid plans |
We bill normal newborn care in the hospital or birthing center (99460–99463), discharge services (99238/99239), and neonatal and pediatric critical and intensive care (99468–99480) for pediatric hospitalists and neonatologists, with the correct place of service and global-period rules.
Problem visits for otitis media, strep, asthma, and influenza; in-office tests (87880 rapid strep, 87804 influenza); nebulizer treatments (94640); ADHD and asthma follow-up; after-hours services (99050/99051) where payers allow; prolonged services (99417); and pediatric telehealth visits, each coded to the documentation and the payer's rules. urgent care billing services
We manage the full revenue cycle for pediatric practices, customized to your payer mix, vaccine program, and visit volume. Choose complete revenue cycle management or the services you need most.
We confirm active coverage, the subscriber and relationship, Nevada Medicaid vs Nevada Check Up eligibility, well-visit frequency limits, and vaccine coverage before the appointment. Eligibility Verification
Certified coders check age-based preventive codes, modifier 25 on sick visits, vaccine component counts, screening instruments, and diagnosis specificity on every claim. Medical Coding
We separate VFC and private stock, add NDCs and modifier SL where required, and compare private-stock vaccine payments to your purchase cost so underpaying contracts get flagged.
Claims are scrubbed for age and code mismatches, subscriber relationship, NCCI edits, and payer-specific screening rules, then submitted within 48 hours.
We fix and appeal denials for bundled screenings, missing modifiers, eligibility, and coordination of benefits, and track patterns by payer. Denial Management
We post ERAs daily and work every open claim by value and timely filing deadline, including the small balances that add up in high-volume pediatrics. Payment Posting · AR Follow-Up
Statements go to the right guarantor with clear explanations of copays and deductibles, plus payment plans and friendly reminders. Patient Billing
We enroll new providers with Nevada Medicaid, the five MCOs, TRICARE, and commercial plans, and keep CAQH and revalidations current. Credentialing
We compare your fee schedules and vaccine reimbursement to what each payer actually pays, so you know which contracts to renegotiate.
Monthly reports show collections by provider, payer, and visit type, plus vaccine margin, screening capture, denials, and A/R aging. Revenue Cycle Management
In pediatrics, the patient is never the policyholder. These are the family-coverage problems we resolve before they become denials:
Newborns without their own ID yet: some plans require early claims under a parent's ID, while others hold them until the baby is enrolled. We track each plan's newborn enrollment window and resubmit under the baby's ID when it's issued.
Relationship to subscriber: a child entered as "self" instead of "child" is one of the most common pediatric denials. We check it on every new patient.
Two parents, two plans: we apply coordination-of-benefits rules, usually the "birthday rule" (the plan of the parent whose birthday comes first in the year pays first), unless a custody order says otherwise.
Medicaid as payer of last resort: when a Nevada Medicaid or Check Up child also has private coverage, we bill the other plan first and Medicaid second, except where Nevada Medicaid allows direct billing for VFC administration.
The right guarantor: statements go to the responsible adult, not the child, with the correct address for families who live in two households.
Vaccine administration and VFC coding check
Sick + well and screening capture review
Private-stock vaccine payment vs cost analysis
HIPAA compliant · No obligation
| Denial cause | How we resolve it |
|---|---|
Preventive code doesn't match the child's age | Recode to the correct age band and resubmit |
Sick visit denied as included in the well visit | Add modifier 25 when the problem was separately documented, or appeal with the note |
VFC vaccine billed with a charge, or private stock billed with SL | Correct the charge and modifier, then resubmit |
Vaccine claim missing NDC | Add NDC and resubmit |
Administration units don't match vaccine components | Correct 90460/90461 counts and resubmit |
Screening denied as bundled | Appeal where the payer covers it separately, or adjust future billing to policy |
Patient entered as "self" or wrong subscriber | Correct relationship and subscriber data |
Other insurance primary (coordination of benefits) | Bill the primary plan first, then Medicaid or the secondary plan |
Well visit exceeds frequency limit | Check the periodicity schedule and appeal if the visit was due |
Immunization counseling (90482–90484) not covered | Confirm payer policy and set billing rules per plan |
| Practice type | What we handle for you |
|---|---|
Solo pediatricians and small practices | Full billing without hiring staff |
Multi-provider pediatric groups | Provider-level reporting and centralized credentialing |
Pediatric NP-led clinics | Billing and enrollment under each NP's NPI |
Pediatric urgent care and after-hours clinics | High-volume sick visits, in-office tests, after-hours codes |
Medicaid-heavy and community pediatric practices | Healthy Kids, VFC, Nevada Check Up, and five MCOs |
Pediatric hospitalists and neonatologists | Newborn, inpatient, and NICU professional billing |
Adolescent medicine practices | Confidential-service billing and adolescent screenings |
Practices adding behavioral health | ADHD and behavioral follow-up, plus referral coordination for ABA ABA billing services |
| Payer category | Plans |
|---|---|
Nevada Medicaid | Fee-for-service, Healthy Kids (EPSDT) under MSM Chapter 1500 |
Nevada Check Up | Nevada's Children's Health Insurance Program |
Nevada Medicaid managed care | Anthem Blue Cross and Blue Shield, CareSource, Health Plan of Nevada, Molina Healthcare of Nevada, SilverSummit Healthplan |
Commercial | Anthem BCBS Nevada, UnitedHealthcare, Aetna, Cigna, Hometown Health, Prominence Health Plan |
Marketplace | Nevada Health Link plans |
Military | TRICARE (families at Nellis and Creech Air Force Bases and across Nevada) |
We bill in the systems pediatric practices use, including Office Practicum, PCC EHR, athenahealth, eClinicalWorks, Epic, NextGen, Tebra/Kareo, AdvancedMD, and DrChrono. No software change needed. EHR Integration
Free pediatric billing audit: We review 90 days of well visits, sick visits, vaccine claims, screenings, and denials.
Secure setup: We sign a BAA and connect to your EHR, clearinghouse, and payer portals.
Vaccine and fee schedule review: We map VFC vs private stock, NDC rules, and vaccine payments against your purchase costs.
Payer rule mapping: We confirm each payer's screening, modifier 25, and well-visit frequency rules.
Go-live: Daily coding, charge review, and claim submission begin.
Legacy A/R cleanup: We work old claims in parallel, starting with high-value and near-deadline claims.
Monthly review: KPI report and a call with your dedicated account manager.
These are the performance standards we manage your revenue cycle to, based on industry best practices.
| KPI | What it measures | Best-practice target |
|---|---|---|
First-pass clean claim rate | Claims paid without rework | 95% or higher |
Net collection rate | Collectible dollars actually collected | 96% or higher |
Denial rate | Claims denied on first submission | Under 5% |
Days in A/R | Average time from visit to payment | Under 35 days |
A/R over 90 days | Share of balances older than 90 days | Under 15% |
Claim submission | Time from visit to claim sent | Within 48 hours |
Combination vaccines billed with too few 90461 units
Sick visits at checkups billed without modifier 25, or not billed at all
Developmental, behavioral, and maternal depression screenings never captured
Private-stock vaccines paid below purchase cost
Newborn claims denied for subscriber or relationship errors
Immunization counseling time (90482–90484) unbilled with payers that cover it
Pediatric billing services are usually priced as a percentage of monthly collections, commonly 3–7% for primary care specialties including pediatrics. High-volume practices with clean payer mixes typically sit at the lower end; practices needing heavy A/R cleanup or credentialing sit higher. There are no setup fees, the agreement is month-to-month with 30-day notice, and you get a fixed quote after your free audit.
| Factor | In-house biller | Nevada Medical Billing |
|---|---|---|
Vaccine and VFC coding | Errors common under pressure | Checked on every claim |
Screening capture | Often missed | Billed per payer rules |
Flu and RSV season backlogs | Claims pile up | Team scales with volume |
Nevada Medicaid and five MCOs | Learned by denial | Already mapped |
Absences and turnover | Billing stops | Backup team keeps working |
Cost | Salary, benefits, software | One fee tied to collections |
"Our cash flow will drop." We work old A/R in parallel while new claims go out.
"Our vaccine billing will get messed up." VFC and private-stock rules are mapped before go-live.
"We'll lose visibility." You see every claim in your own EHR, plus a monthly review call.
"We're locked in." You're not. The agreement is month-to-month with 30-day notice.
Pediatric billing follows CPT and ICD-10-CM guidelines, Nevada Medicaid MSM Chapter 1500 (Healthy Kids/EPSDT), Vaccines for Children program rules, NCCI edits, payer policies, and HIPAA, including extra care with adolescent confidential services.
Whole-visit coding: preventive, sick, vaccine, and screening lines captured together.
Vaccine revenue protected: VFC rules applied, private-stock payments checked against cost.
Nevada expertise: Healthy Kids, Nevada Check Up, VFC, and five Medicaid MCOs.
Family coverage handled: newborns, coordination of benefits, and guarantors done right.
Primary care depth: the same team bills family medicine and internal medicine.
No lock-in: month-to-month agreement with 30-day notice.
Las Vegas: Pediatric groups, pediatric urgent care, and hospital-affiliated pediatricians across the valley. Las Vegas page
Henderson: Growing pediatric practices with heavy commercial and family-plan volume. Henderson page
North Las Vegas: Medicaid-heavy pediatric practices and military families near Nellis AFB. North Las Vegas page
Reno: Pediatric practices serving Washoe County and rural northern Nevada families. Reno page
Carson City: Pediatric and family practices billing CareSource and SilverSummit for rural children. Carson City page
We also support pediatric practices in Sparks, Summerlin, Pahrump, Elko, and Mesquite.
We help Nevada pediatric practices capture every billable service, bill vaccines correctly, and collect from families and payers without the backlog.
Free 90-day review · No obligation · HIPAA compliant
Primary care billing servicesInternal medicine billing servicesUrgent care billing servicesABA billing servicesPediatrics billing services cover eligibility checks, coding, vaccine billing, claim submission, payment posting, denial appeals, A/R follow-up, credentialing, and family billing for pediatric practices.
Bill the age-based preventive code plus a separate problem-oriented E/M (99212–99215) with modifier 25, as long as the problem was significant and separately documented. A minor issue handled within the checkup is part of the preventive visit.
90460 is for patients through age 18 when a physician or qualified health professional counsels on the vaccine. It covers the first component, with 90461 for each additional component. 90471–90474 are used when those requirements aren't met.
Nevada Medicaid and Nevada Check Up don't pay for VFC vaccine products, so they're billed at a zero charge or with modifier SL, with the NDC. The administration is billed with the appropriate CPT code.
Since January 1, 2026, CPT codes 90482–90484 report immunization counseling by total time when no vaccine is given that day. Medicare doesn't pay them and coverage varies, so we confirm each payer's policy first.
Often developmental screening (96110), behavioral assessments (96127), maternal depression screening (96161), vision (99173/99177), hearing (92551/92552), lead and anemia tests, and fluoride varnish (99188). Some payers bundle certain screenings into the preventive visit.
It depends on the plan. Some accept early claims under a parent's ID; others require the baby's own ID once enrolled. We track each plan's newborn enrollment window and resubmit when the ID is issued.
Usually the plan of the parent whose birthday comes first in the calendar year (the "birthday rule"), unless a custody order assigns responsibility.
Most charge 3–7% of collections, depending on volume, payer mix, and services. We give a fixed quote after a free audit.
Outsourcing makes sense when vaccine and screening revenue is slipping, denials are rising, or billing staff fall behind in flu and RSV season. You keep full visibility, and our agreement is month-to-month.