Vaccines, screenings, and contracts run pediatric margin. Most clinics have at least one fixable leak.
Pediatrics is volume-driven and margin-thin. Vaccine acquisition cost, developmental screening capture, and payer contract terms are the three biggest levers, and they're all measurable.
What we see again and again in pediatric practices
- Vaccine acquisition cost not benchmarked against VFC and group purchasing options
- Developmental screenings (96110) and behavioral assessments (96127) under-billed
- Lactation, asthma education, and care coordination not captured under available codes
- Sick-visit no-show rate eroding scheduled capacity
Pediatrics reference data
Every report compares your numbers against published peer data. Sources include MGMA, CMS, and specialty-society reports.
| Metric | Reference value | Source |
|---|---|---|
| Vaccine margin as % of revenue, peds median | 12–18% | MGMA + AAP |
| 96110 billing rate vs. AAP recommended schedule | ~52% capture | AAP study |
| Established visit revenue, peds median | $98–$132 | MGMA 2024 |
Recommended report order for pediatrics
You don't need all four. Start with the one we recommend first — most owners stop there because it surfaces enough to act on for the next 90 days.
- 1
Revenue expansion
$0Ranks your top 8–10 revenue expansion opportunities by specialty, staff, and payer mix.
- 2
CPT and billing review
$0Specialty-specific coding checklist with commonly missed codes, modifier traps, and a 30-day fix list.
- 3
Payer mix and contracts
$0Benchmarks your payer mix against peers and flags the contracts most worth renegotiating.
- 4
Staff utilization
$0Identifies whether your NPs, PAs, and licensed staff are billing at full scope.
Common dollar findings in pediatrics
Pulled from patterns we see across audits. Your numbers will differ, but the categories are remarkably consistent.
- Missed 96110 screenings worth $8K–$22K/year
- Vaccine acquisition 8–14% above benchmark
- Lactation consult revenue ($9K–$18K/year) recoverable
- Payer mix re-shaping toward 2 commercial contracts adds $40K–$85K/year
FAQ for pediatrics owners
Do you account for VFC vs. private inventory?+
Yes. Intake captures your VFC/private split and the report models the margin difference plus group purchasing scenarios.