In 2025, the American Medical Association (AMA) added new telehealth CPT codes for pediatric care. Telemedicine has grown, so these codes help describe video and audio consultations better. Pediatric practice leaders need to know these changes for proper billing and compliance.
These codes help capture how long and complex virtual visits are. Telehealth use increased after COVID-19, so these codes help providers bill more accurately and avoid denials.
Practices must train billing and IT staff to add these codes to their systems. Without updates, claims may be submitted wrong and cause payment delays. This affects the practice’s finances.
Vaccines make up a big part of pediatric care. In 2025, the CPT updates added or changed some vaccine codes. Billing teams need to use the new codes properly to get paid and avoid audits.
There are also rules about billing vaccines given with or without counseling. Counseling codes (e.g., 90460–90461) differ from non-counseling codes (90471–90474). Using the wrong code can cause claim denials and slow payment.
Billing staff and EHR administrators must update their systems to include these codes. Failure to do so could mean missed payments or services not billed.
RTM is a way to watch children with long-term illnesses from a distance. In 2025, new CPT codes for RTM help track these services and get paid for them.
These codes recognize that technology like home devices and apps can help track patients’ health and therapy progress. Pediatric practices can offer these services and receive payment when billed right.
Staff training and system upgrades are needed to document and bill for RTM properly. Without good workflows, claims could be denied or delayed.
There are some common problems with the new CPT codes for pediatric care:
Ongoing training, software updates, and compliance checks can help. Some practices hire outside experts to manage billing better.
Artificial intelligence (AI) and automation can help make pediatric coding and billing easier and more accurate. Some companies offer AI tools for this work.
These AI tools reduce mistakes, avoid denials, and speed up payments. They also let staff spend less time on paperwork and more on patient care. This aligns with trends focusing on accurate and detailed billing for good reimbursement.
Pediatric healthcare administrators in the US need to take action on these 2025 updates:
Pediatric care is changing with more telehealth, new vaccines, and digital monitoring. Billing must change too. The 2025 CPT codes show this by adding detailed pediatric service codes.
Hospital leaders and practice owners in the US should focus on these changes. Updating systems, teaching staff, and improving workflows will protect payments and reduce errors.
With good training, technology, and automation, practices can handle pediatric coding challenges and provide good care following AMA guidelines.
Pediatric medical coding is the process of assigning CPT and ICD-10 codes specifically for children’s healthcare services, taking into account age, growth percentiles, vaccines, screenings, chronic conditions, and developmental factors to ensure accurate billing and reimbursement.
Pediatric coding differs by requiring age-specific preventive visit codes, component-based vaccine administration codes, mandatory ‘why-not’ ICD-10 Z-codes explaining missed vaccines or screenings, BMI percentile growth modifiers, and chronic condition categorizations unique to children, all of which impact reimbursement and compliance.
Challenges include assigning accurate ICD-10 codes for unique pediatric conditions, ambiguity in diagnoses, frequent code updates, technology integration issues with EHRs, undertrained staff, and billing nuances like managing multiple siblings under one guarantor, all causing claim denials and revenue loss.
Important codes include age-specific well-child CPT codes (99381-99395), immunization administration codes (90460-90474), telehealth CPT codes (98000-98016), ICD-10 codes for common pediatric conditions (e.g., J45.20 for asthma), and Z-codes for abnormal findings or refusals like Z00.121 and Z28.3.
AI agents automate visit note structuring, accurately assign ICD/CPT codes with rationale, validate payer rules, submit clean claims, and monitor denials. This reduces errors, avoids denials upstream, speeds reimbursement, and frees clinical staff to focus on patient care.
The workflow includes: 1) Collecting and reviewing documentation; 2) Determining visit type and selecting CPT codes; 3) Adding procedural and immunization codes; 4) Mapping diagnoses to ICD-10; 5) Applying modifiers; 6) Validating payer rules; 7) Submitting claims and tracking denials.
‘Why-not’ Z-codes explain missed vaccines or screenings (e.g., vaccine refusal), clarifying why recommended services were not provided. Skipping these codes often causes claim denials due to perceived missing or incompatible diagnoses.
Amy scans provider notes in the EHR, assigns accurate ICD, CPT, and E/M codes along with detailed rationales, updates codes back to the EHR, and flags documentation gaps, significantly improving coding accuracy and compliance.
AI denial management proactively monitors accounts receivable, flags priority claims, checks payer portals, makes AI-driven calls for status updates, escalates appeals, and audits denied claims to prevent recurring errors, accelerating payment recovery and reducing revenue leakage.
2025 updates introduced new telehealth CPT codes (98000–98016) for video, audio-only, and virtual check-ins, new pediatric vaccine codes like PCV-21, and expanded remote therapeutic monitoring codes (98975–98978), reflecting evolving care delivery models and clinical realities.
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