Billing > Facility Billing

Need Billing Picture for Medical Visit for Children under Facility


Hi Everyone,
I am a veteran mental health biller. Since my job is moving towards actually billing for their medical services, my team and I will be moving forward in that field as well. We are currently on a board assisting in setting up our system for billing- Go live date is July 1st - and I need help understanding the billing flow for medical services from start to finish. We service children, so if a child comes in for a well visit How is billing set up and triggered to pick up all required codes and modalities.

Example: Jane (age 8) comes in for her annual, she is examined by the provider = E/M, the provider then orders her the Flu shot, blood work, eye/hearing test. What does your encounter look like to cover all these services?

I know E/M services = provider F2F time in the office and I believe for the most part they should be set up by time (correct me if I'm wrong) but then how does the vaccines, labs and other testing play a part in the claim?

There are specific E/M codes for well visits.  They range from 99381-99397.  So you would include the E/M code for the well visit.  If the vaccines are done right then/there in the office you would include the hcpcs code for the vaccine and the administration charge.  There are two codes for each vaccine, the one for the actual substance and one for the administration of that substance.  When giving vaccines the 25 modifier may be considered for the E/M code if appropriate.  Otherwise the vaccines and E/M may be bundled.  I'm not advising to automatically include the 25 modifier, but if it's appropriate and the notes support that then you would want to. 

Usually patients are sent out for labs so the lab charges are billed by the lab directly.  There are also codes for Vision and Hearing screenings.  Vision screenings are 99172-99174 and hearing screenings are 92551, 92587.  Here is a good resource: 

Thank you!


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