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Welcome  » May 26, 2024 4:13 AM
Program Name: BadgerCare Plus and Medicaid Handbook Area: HealthCheck (EPSDT)
05/26/2024  

Covered and Noncovered Services : Covered Services and Requirements

Topic #11239

Blood Lead Screening Test

A capillary finger stick test can be done for a blood lead screening test. A confirmatory blood test is required only if the capillary blood lead level is 3.5 mcg/dL or greater.

Providers may be reimbursed for collection of a capillary blood specimen (for example, finger, heel, ear stick) using CPT procedure code 36416 (collection of capillary blood specimen [e.g., finger, heel, ear stick]). This procedure is frequently used when doing a finger stick blood draw for blood lead testing.

Providers may be reimbursed for CPT procedure code 36416 and lab handling fee CPT procedure code 99000 when drawing a finger stick blood specimen to be mailed to the laboratory for analysis.

Providers may be reimbursed for CPT procedure code 36416 and CPT procedure code 83655 (Lead) when doing on-site blood lead testing. Providers will not be reimbursed for the lab handling fee CPT procedure code 99000 in this situation.

Blood Lead Testing at WIC Clinics

The WIC Program's role is to assess and refer participants to health care providers for blood lead testing. WIC offices that do not provide blood lead testing are encouraged to:

  • Refer participants who have children ages 12 and 24 months for a blood lead test.
  • Refer participants who have children between 24 and 72 months with no record of a previous blood test.

For blood lead tests completed at a WIC office, the result is uploaded to the Wisconsin Blood Lead Registry.

HealthCheck providers should ensure they follow blood lead level testing guidelines.

Wisconsin Blood Lead Registry

The Lead Registry is a web-based tool that allows providers to check a child's blood lead testing history online during an office visit. The Lead Registry is linked to the WIR and updated by WCLPPP each week with new test results done at all locations, including WIC, Head Start, and physicians' offices. The Lead Registry can help providers easily identify children who have not yet been tested or are due for another test. For information on how to access the Lead Registry, providers may contact the WCLPPP.

Office-Based Blood Lead Testing

Providers are encouraged to draw capillary (finger stick) blood lead samples within their office or clinic. Performing the finger stick in the clinic ensures the test is completed. If the child is referred to an outside area, the test may not be done.

Providers wanting to provide blood lead testing in their office should follow Clinical Laboratory Improvement Amendment requirements. CLIA requires laboratories and providers performing tests for health assessment or for the diagnosis, prevention, or treatment of disease or health impairment to comply with specific federal quality standards.

 
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