MIPS Value Pathways for Pediatrics: Who Actually Has to Report by 2029
CMS proposes ending traditional MIPS after 2028, making MIPS Value Pathways mandatory in 2029. Most pediatric practices are exempt. Here is how to check.
Resources
Explore tips and insights to revolutionize Pediatrics medical billing for improved efficiency and profitability.
99204 CPT Code: New Patient Office Visit Billing for Pediatric Practices
CPT code 99204 covers new patient office visits with moderate MDM or 45-59 minutes. Get 2026 rates, documentation rules, and pediatric billing tips.
CPT Code 99381: New Patient Infant Well-Child Visit Billing for Pediatric Practices
This code is specifically used for comprehensive preventive medicine services for infants under the age of one year. It covers a thorough evaluation and management process tailored to the needs of a new patient in this age group.
CPT Code 99392: Well-Child Visit Billing Guide for Ages 1 to 4
This code is used for comprehensive preventive medicine services for early childhood patients, specifically aged 1 through 4 years. It encompasses a thorough evaluation and management process, tailored to the developmental stage and health needs of this age group.
October 2026 Medicaid Eligibility Changes: What Pediatric Practices Must Prepare for Now
What Is Changing With Medicaid in October 2026? Starting October 1, 2026, the 2025 reconciliation law (H.R. 1) narrows Medicaid eligibility for certain immigrant populations, restricting coverage to lawful permanent residents, certain Cuban and Haitian
Modifier 59 in Pediatric Billing: 2026 NCCI Rules, X Modifiers, and When to Use Each
What Is Modifier 59 in Medical Billing? Modifier 59 is a CPT modifier that identifies a procedure or service as distinct and separate from another non-E/M service performed on the same date by the same
Childhood Vaccine Schedule Changes: What Pediatric Practices Need to Know About Billing in 2026
The August 2026 vaccine executive order changes how pediatric practices bill immunizations. See what moved, what stays covered, and what to do now.
CPT Code 99214 for Pediatric Practices: 2026 Time, MDM, and Modifier 25 Billing Guide
What Is CPT Code 99214? CPT code 99214 is a level 4 office or outpatient evaluation and management visit for an established patient. It requires moderate complexity medical decision making, or 30 to 39 minutes
How to Prepare Your Pediatric Billing for Beyfortus and Immunization Changes
What Billing Changes Affect Pediatric RSV Prevention This Season? The 2026-2027 RSV season begins in approximately October and runs through March, and pediatric practices must prepare their billing workflows now for three developments that affect
2027 Medicare Payment Changes for Pediatrics: The Modifier 25 Cut, Conversion Factor, and What to Do Now
What are the 2027 Medicare payment changes for pediatric practices? As of July 2026, the CMS calendar year 2027 Physician Fee Schedule proposed rule (CMS-1848-P) would cut the Medicare conversion factor by 1.19 to 1.68
