When it comes to running a successful pediatric practice, providing excellent care isn’t the only priority—getting paid accurately and on time is just as critical. Yet many pediatricians across Maryland struggle with billing complexities that cost them revenue, time, and peace of mind.
Whether it’s underbilling vaccine administration, getting denials on same-day sick and well visits, or dealing with changing Medicaid rules, pediatric billing has unique challenges. At Global Tech Billing LLC, we help pediatric providers across Maryland overcome these hurdles through smart coding, payer-specific insight, and denial prevention strategies that actually work.
This article breaks down the essentials of pediatric medical billing in Maryland—common CPT codes, payer trends, practical tips, and proven tactics to help your practice code smarter and get paid faster.
Why Pediatric Billing Is Different—and More Challenging
Pediatrics involves a high volume of low-cost visits, constant coding updates, and a wide range of services—from preventive vaccines to complex developmental screenings. Billing mistakes may seem small, but they add up quickly and can silently drain thousands each year. Internal medicine billing often involves a broad code range. For better accuracy and collections, review this guide on
internal medicine billing.
Common pain points for pediatricians in Maryland:
- Denied vaccine administration codes
- Confusion over same-day sick and well-visit billing
- Missed developmental screening reimbursements
- Medicaid MCO payment discrepancies
- Bundled services are not billed separately
Key Pediatric CPT Codes Every Maryland Practice Should Know
Billing accuracy starts with using the right codes for the right services. Here are commonly used pediatric CPT codes:
Evaluation and Management (E/M) Services
- 99213 / 99214 – Established patient office visits
- 99203 / 99204 – New patient visits
Tip: Proper documentation of time, medical decision-making, and visit complexity is now essential under the 2021 E/M guidelines.
Vaccinations
- 90460 – Immunization admin through age 18 (1st component)
- 90461 – Each additional component administered
- 90698, 90700, 90713, 90633 – CPTs for various vaccines
Reminder: Always bill both the administration code and the vaccine product code. For Medicaid, include NDC numbers.
Developmental and Behavioral Screening
- 96110 – Developmental screening (e.g., ASQ, M-CHAT)
- 96127 – Emotional/behavioral screening (e.g., PHQ-9, Vanderbilt)
Many practices skip these despite payers reimbursing $6–$10 per screen. Multiply that across hundreds of visits, and it’s thousands in missed revenue. OB/GYN practices face frequent denials due to bundled services. This guide offers tips for optimizing OB/GYN billing and improving claim approval.
Same-Day Sick and Well Visits: Avoiding Denials
One of the most common billing misconceptions is that you can’t bill a well-child visit and a sick visit on the same day. You can—but you must follow the rules.
How to bill it correctly:
- Use 99391–99395 for the preventive service
- Use 99213–99215 for the sick visit
- Append Modifier 25 to the E/M sick code
- Documentation must clearly separate both services
Example: A 4-year-old comes for a routine check-up (99393) and also has an ear infection. Bill 99393 and 99213–25.
Many Maryland payers, including CareFirst and Aetna, accept this format—but only if documentation supports it.
Maryland Medicaid & MCO Specifics
Maryland Medicaid and its Managed Care Organizations (MCOs) such as Priority Partners, MedStar Family Choice, and Amerigroup, have unique requirements.
Common issues we’ve seen:
- Missing NDC codes for vaccines (required for reimbursement)
- Global payment delays on newborn visits
- Capitation confusion for well visits
At Global Tech Billing LLC, we stay up to date with each MCO’s policies to reduce claim rejections. For example, we maintain direct contact with Maryland Medicaid representatives and track real-time updates to vaccine schedules, encounter forms, and claims logic.
Smart Coding Strategies to Boost Pediatric Revenue
Maximize Screening Code Usage
Many payers reimburse 96110 and 96127 up to 4 times per year if medically necessary. Don’t leave these codes unbilled.
Split Vaccine Admin and Product Codes
You must separately bill the administration (90460/90461) and the vaccine product code (e.g., 90698). Always include lot number and manufacturer for documentation.
Track Well Visit Frequency Limits
Annual well-child visits are only reimbursed once per calendar year (or once every 365 days depending on the payer). Train front office staff to verify eligibility and last visit date.
Case Study: Faster Payments, Fewer Write-Offs
A 3-provider pediatric group in Prince George’s County was experiencing a 19% denial rate—primarily due to incorrect vaccine administration coding and missed developmental screenings.
After partnering with Global Tech Billing LLC, we:
- Reduced their denial rate to under 6%
- Implemented screening code tracking and reminders in their EHR
- Recovered over $28,000 in denied and missed claims in the first 3 months
We also helped the practice switch to electronic claims submission with Maryland Medicaid, speeding up reimbursement time by 30%.
Documentation Tips for Pediatric Billing Success
What insurers want to see:
- Well-child visits: growth charts, immunization status, developmental milestones, anticipatory guidance
- Sick visits: separate note with clear history, exam, and plan
- Screenings: results of tools (e.g., M-CHAT), parent responses, follow-up plan if positive
Accurate documentation protects your claims and prevents takebacks during audits.
Cardiology billing includes high-complexity CPT codes and time-based services. Boost accuracy with these essential tips for cardiologist medical billing.
Why Choose a Pediatric-Specific Billing Partner?
At Global Tech Billing LLC, we specialize in pediatric billing across Maryland. Unlike general billing companies, we understand the nuances of child-specific codes, vaccine schedules, and state Medicaid requirements.
Here’s what we offer:
- Expert CPT code selection for pediatrics
- Vaccine and immunization tracking
- Denial prevention workflows
- Real-time A/R dashboards and reporting
- Local payer expertise and direct rep access
Whether you’re a solo pediatrician or a busy group practice, our goal is to help you code smarter, collect faster, and eliminate billing stress.
Conclusion: Stop Leaving Pediatric Revenue on the Table
Your pediatric practice deserves to get paid for every service delivered—with no unnecessary delays or write-offs. But without the right billing strategy and partner, missed revenue becomes inevitable.
By working with Global Tech Billing LLC, Maryland pediatricians gain access to pediatric-specialized coders, local payer experts, and a transparent RCM process that’s built for growth. We help you navigate sick and well-visit rules, optimize vaccine claims, and ensure your documentation supports every dollar.
FAQs
1. Can I bill a sick and well visit on the same day for a child?
Yes, if both are medically necessary and documented separately. Use Modifier 25 on the sick visit E/M code.
2. What’s the most commonly denied pediatric code in Maryland?
Vaccine administration codes (90460/90461) often get denied due to missing NDCs or incorrect linkage to vaccine product codes. Visit our Maryland Billing Service page to learn more.
3. Are developmental screenings reimbursable?
Yes. Most payers—including Medicaid—reimburse CPT 96110 and 96127 when medically necessary and properly documented.
4. How can I reduce vaccine claim denials?
Ensure each vaccine is paired with its administration code, and always include NDC number, lot number, and manufacturer in documentation.
5. Why choose Global Tech Billing LLC for pediatric billing?
We specialize in pediatric RCM for Maryland practices, with in-depth knowledge of local payers, Medicaid nuances, and coding strategies that boost collections.
