Pediatric Billing Services in Texas| 30% Reduction In AR
Pediatric practices across Texas lose revenue due to strict rules that apply nowhere else. Transcure bills pediatric claims correctly under all the rules & regulations of Texas, at a 98% first-pass clean claim rate for 5% of collections.
- Comply with Texas balance billing restrictions and No Surprises Act requirements.
- Capture full TVFC vaccine administration revenue through codes 90460, 90461, and 90471.
- Route STAR, STAR Kids, STAR Health, and CHIP claims under plan-specific rules.
- Prevent incomplete checkup denials caused by missing developmental screening tool documentation.
- Reduce front-end rejections through eligibility checks across Texas Medicaid and CHIP.
Our Success in Numbers
Trusted by
500+ Physicians
Catering to
40+ Specialties
1100+ Certified
Medical Billers & Coders
End-to-End
RPA Billing Solutions
Up to 98% First Pass
Clean Claim Rate
What Are the Main Reasons Texas Pediatric Practices Suffer Revenue Loss and Denials?
Pediatric practices in Texas face four revenue-impacting billing failures that drive the majority of denials:
- Incomplete Texas Health Steps Checkups: Texas Medicaid treats a checkup as incomplete when screening tools are missing, making the visit non-reimbursable. Our AI agents validate every component before submission.
- Lost TVFC Vaccine Administration Revenue: Texas Medicaid does not reimburse TVFC-supplied vaccines, so under-billed administration codes cost the only payable line. We bill 90460, 90461, and 90471 with accurate component counts.
- Missed 95-Day TMHP Filing Deadlines: The pediatric practices in Texas give only 95 days to file a claim. Transcure closes charges daily and flags aging claims before the deadline passes.
- Modifier 25 Denials on Same-Day Visits: Pediatric clinics bill sick visits and well-child checkups together every day. Our AI agent confirms the documentation supports modifier 25, then appeals to any evaluation and management line denied.
Pediatric Practices That Trust Transcure
Pediatric practices nationwide choose Transcure to manage their medical billing needs. We handle the complexities of insurance claims and payment processing, allowing physicians to focus more on patient care and less on administrative burdens. Practices we work with include:
What Services Transcure Provides for Pediatrics Coding and Billing Services?
Transcure runs the full pediatric billing services for Texas practices, with certified coders and AI agents working each stage:
Insurance Eligibility Verification
Transcure’s ELIXA AI agent verifies Texas Medicaid, STAR, STAR Kids, CHIP, and commercial coverage before every pediatric visit to stop eligibility denials.
Prior Authorization and Treatment Validation
Our PRIA AI agent manages authorizations for pediatric therapy, behavioral health, DME, and specialty referrals so treatment starts without payment delays.
Pediatric Coding and Charge Capture
Our CODIN AI agent and certified coders apply accurate CPT, ICD-10, and modifier logic across checkups, immunizations, newborn care, and sick visits.
Pediatrics Denial Management and Appeals
DEXA AI is our best agent that identifies denial trends across Texas payers and appeals rejected pediatric claims inside the 90-day Texas Medicaid appeal window.
California Regulatory Compliance
We don’t just follow national billing rules. We also follow California’s specific laws that protect patients from surprise bills and make sure insurance companies pay doctors on time.
Fast Onboarding
Practices go live in 5-7 days, integrating smoothly across 43+ EHR systems with no disruption to existing pediatric workflows or staff.
Which Cities Does Transcure Support with their Texas Pediatric Billing Services?
Transcure supports pediatric practices across every major Texas metro, from large multi-site groups to single-provider clinics serving Medicaid and CHIP families.
View All Cities
Austin, Texas
Fort Worth, Texas
Abbott, Texas
Corpus Christi, Texas
El Paso, Texas
Plano, Texas
Irving, Texas
Nationwide Pediatrics Billing Support by Transcure
Transcure provides pediatric billing and coding support nationwide, adapting to each state’s payer rules and compliance requirements.
Which Counties Does Transcure Support with their Texas Pediatrics Billing Services?
Transcure supports pediatric practices in the Texas counties where child populations are largest, and Medicaid and CHIP volume runs highest.
Andrews County, Texas
Aransas County, Texas
Bexar County, Texas
Tarrant County, Texas
Collin County, Texas
Travis County, Texas
How Does Transcure Handle Texas Medicaid and CHIP Claims?
We file Texas Medicaid and CHIP claims through the right MCO rules from the start. Texas does not run one Medicaid program. Your patients sit across Superior HealthPlan, Amerigroup, Texas Children’s Health Plan, Community Health Choice, and others. Each plan has its own filing window, prior authorization list, and claim format.
Our billers check eligibility before every visit through ELIXA. This catches coverage changes and plan switches before the child walks in. PRIA clears prior authorizations so your staff stops chasing approvals by phone. For THSteps checkups, we confirm the periodicity schedule and file the correct age-based codes. We track timely filing deadlines per plan. Denied Medicaid claims go straight to appeal with the documentation attached.
What Types of Procedures Does Transcure Handle With Their Pediatric Billing Services?
Transcure bills the full range of pediatric procedures performed across Texas practices, from routine preventive care to hospital-based newborn services. Here are few of the all procedures supported by us:
Well-Child Visit Billing
Every Texas Health Steps checkup carries required components. We confirm each one appears in the record, then bill the correct preventive code according to the child's age.
Immunization & Vaccine Administration Billing
Texas Medicaid pays for giving the vaccine, not the vaccine itself. We report administration codes with accurate component counts, so no dose in your schedule goes unpaid.
Newborn and Nursery Care Billing
Newborn care includes initial hospital evaluation, daily nursery visits, and discharge day management. Our coders match each service to the correct code and document birth weight where payers require it.
Developmental and Behavioral Screening Billing
Autism, developmental, and mental health screenings pay separately from the checkup. We verify the validated tool appears in the note before billing, which stops the most common Texas denial.
Same-Day Sick and Preventive Visit Billing
Children often arrive sick on the day of a scheduled checkup. We confirm the record supports two distinct services, apply modifier 25, and appeal any evaluation and management line denied.
Minor Office Procedure Billing
Laceration repair, foreign body removal, nebulizer treatments, and circumcision all happen in the pediatric office. We bill each with correct modifiers and prevent bundling losses against the same-day visit.
Our Comprehensive Pediatric Billing Audit Services
Delayed payments, claim rejections, increased administrative work, and regulatory risks results in $100,000 to $150,000 loss every year in pediatric practice collections. Providers don’t know, but they can save this money if they run professional practice audits twice a year, as these expert audits help them identify potential errors in their RCM before they cause any revenue loss.
To help pediatric practices and centers save money and avoid denials, Transcure pediatric billing company provides complimentary pediatric billing audit services with complete RCM. Contact us and let our professionals identify all the problems in your RCM before it’s too late.
Our Expertise in Pediatric CPT Codes and ICD-10 Coding
Built on years of pediatric billing expertise, our coding specialists ensure your claims are clean, compliant, and properly coded across CPT, HCPCS, and ICD-10 standards. We handle:
99381 to 99384
- Preventive care CPT codes for initial (new patient) well-child visits by age
99391 to 99394
- Preventive care CPT codes for established patient annual well-child examinations
99391 to 99394
- Immunization administration CPT codes through age 18 with physician counseling
90471 to 90474
- Immunization administration CPT codes for injectable, nasal, or oral vaccines without counseling
Z23
- ICD-10 code for encounter for general immunization and vaccine administration
H66.90 to H66.93
- ICD-10 codes for acute otitis media (suppurative and unspecified ear infections)
J02.9 & J06.9
- ICD-10 codes for acute pharyngitis and acute upper respiratory infections
J45.20 to J45.901
- ICD-10 codes for pediatric asthma (mild, moderate, severe, or acute exacerbations)
F90.0 to F90.2
- ICD-10 codes for attention-deficit hyperactivity disorder (ADHD) management
Our Certifications
Transcure’s pediatric billing team holds industry-recognized certifications to ensure every child’s claim strictly adheres to CMS compliance standards, state Medicaid guidelines, and payer-specific coding requirements.
What Pediatrics EHR Systems Are Supported by Transcure?
Transcure supports all primary pediatric EHR systems, enabling our certified coders to gather clinical records and submit claims directly from your current record.
Frequently Asked Questions (FAQs)
Get answers to the most common questions pediatric practices ask about our billing services, ESRD compliance, and CMS reimbursement rules.
How Much Do Pediatric Billing Services Cost?
Transcure charges under 3 to 5% of monthly collections. Pricing scales with what your practice actually collects, so there is no fixed retainer. Setup, system access, and reporting carry no separate fee.
Are Your Billers Certified in Pediatric Coding?
Yes. Transcure staffs 1,100+ AAPC-certified billers, including a pediatric team trained on age-banded E/M selection, immunization component coding, and well-child documentation rules. Assigned coders work pediatric accounts only.
Does Transcure Bill Medicaid and CHIP in Every State?
Yes. Transcure bills Medicaid and CHIP nationwide and tracks state-level rule changes across fee-for-service and managed care. ELIXA verifies coverage category and payer sequence before each claim leaves the system.
Can Transcure Handle Vaccines for Children Program Billing?
Yes. Our coders separate the federally supplied vaccine product from the billable administration fee, apply the state-required modifier, and count vaccine components correctly on every 90460 and 90461 claim.
How Long Does Onboarding Take?
Onboarding completes in 14 days. Week one covers payer enrollment review, system access, and fee schedule loading. Week two covers workflow mapping and parallel claim testing before full cutover.
Pediatric Billing Knowledge Center
Explore the latest Pediatric billing insights to enhance practice performance and profitability.
07/20/2026
Complete pediatric ICD-10 code guide: Z00.121 vs Z00.129, age gates, growth, behavioral and chronic codes, plus the CARC fixes that stop specificity denials.
08/24/2026
Pediatric CPT codes decoded: age-banded well visits, 90460 component counting, modifier 25 placement, and the new 2026 counseling codes 90482 to 90484.
08/24/2026
Complete pediatric ICD-10 code guide: Z00.121 vs Z00.129, age gates, growth, behavioral and chronic codes, plus the CARC fixes that stop specificity denials.