Lead Screenings
Lead Screenings (Medicaid and CHIP)
Lead exposure, especially among young children, continues to be a significant part of the national discussion regarding health issues. According to the Centers for Disease Control (CDC), even low levels of lead in blood have been shown to affect a child’s IQ, their ability to pay attention, and academic achievement. The CDC’s current guidelines reference a blood level of 3.5 micrograms per deciliter to identify children with elevated blood levels.
Both Medicaid and CHIP require lead testing as outlined in the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) and Bright Futures requirements.
Universal blood lead toxicity testing should be completed by 12 months and at 24 months of age. Providers are also required to test children between the ages of 36 and 72 months of age if they have not been previously tested for lead poisoning. Providers may test for blood lead using a capillary sample but must confirm an Elevated Blood Lead Level (EBLL) with a venous blood sample. Additionally, the MA Program provides coverage for blood lead testing of all MA enrolled children under 21 years of age at any time, if indicated by risk assessment, or for those children with a history or symptoms of lead exposure.
Quick Reference
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Lead testing ages |
12 months and 24 months |
Between 36 and 72 months if never tested |
If never tested, please complete at next well child visit |
Medicaid and CHIP Line of Business |
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Method of testing |
Capillary sample but confirm elevated level by venous blood sample |
In office or Quest Diagnostics |
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Elevated lead levels |
3.5ug/dL |
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Home evaluation |
Philadelphia Only |
Fax form to City of Philadelphia |
Form below |
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All other counties |
Accredited Environmental Technology |
Form below |
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Testing
In the event testing is not completed during these timeframes, we urge your office to perform testing at the next well-child visit.
Testing can be conducted in either your office or at a Quest Diagnostics Drawing Station. When you conduct an ‘In-Office Lab Draw’ lead screening test, please note that you should submit CPT code 83655. If the testing occurs at a Quest Diagnostics Drawing Station, be sure to provide a prescription to the parent/guardian to enable them to visit any Quest Diagnostics location. Find the closest testing facility by utilizing the Provider Directory and searching for “Quest Diagnostics.”
Treatment Recommendations
Medical treatment is not recommended for children with blood lead levels lower than 45 micrograms per deciliter, according to CDC recommendations.
Environmental Lead Investigation (ELI) Form
An ELI form is required for members under the age of 21 with a blood lead screening result of at least 3.5 μg/dL, and where there are environmental influences for lead contamination. The order for an ELI must include a primary diagnosis code of toxic effect of lead and its components. It is free for Jefferson Health Plans members. Forms can be found in the box below.
Resources
Jefferson Health Plans encourages providers to check these online resources for more information about preventing lead exposure and removing lead paint from PA homes.
More Information
Please contact county-based health departments and programs that offer resources, screening guidelines and other information.
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County |
Organization |
Phone |
| All Counties (excluding Philadelphia) |
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610-891-0114 |
| Philadelphia |
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215-685-2788 |