Statewide Recommendations for Universal Blood Lead Testing for Children

Starting January 2024, the Wisconsin Department of Health Services (DHS) recommends universal blood lead testing statewide for children under the age of 6.

New Universal Testing Recommendations

Early detection of lead poisoning is critical to prevent further exposure and minimize damage on a child’s health. Universal testing creates an equitable approach to testing children’s blood lead levels and removes confusion about limitations due to age, geographic location, or housing conditions.

Universal testing means all children should get at least two blood lead tests by age 2. Children 3–5 years old should get tested if there is not a record of a previous test.

Starting January 2024, DHS recommends blood lead testing statewide for:

• All children at age 1.
• All children again at age 2.
• Any children between the ages of 3–5 without a previous test.

The above recommendations match the Centers for Medicare & Medicaid Services requirement for children ages 1–2 enrolled in BadgerCare Plus and Wisconsin Medicaid.

Children under 17 years of age can also be tested if:

• Their parent or guardian expresses concern about lead exposure or asks for their child to be tested.
• Their health care provider becomes aware of possible lead exposure or lead poisoning risk factors.
• They are a newly arrived refugee. (The Centers for Disease Control and Prevention recommends blood lead testing at arrival and again three to six months after the initial test.)

For more information and a list of frequently asked questions, providers should refer to DHS’ Lead Safe Wisconsin: Universal Testing webpage. For other questions or concerns, providers may email DHS at dhsleadpoisoningprevention@dhs.wisconsin.gov.

Medicaid-Specific Lead-Related Resources

In addition, providers may refer to the Lead Safe Wisconsin: Medicaid Reimbursement for Lead-Related Services webpage for more information about blood lead testing reimbursement.

Blood Lead Testing Policy

Providers may refer to the following topics in the ForwardHealth Online Handbook related to the current policy and claim submission for blood lead testing:

• Blood Lead Screening Test topic (#11239)
• On-Site Blood Lead Testing topic (#4272)
• Periodicity Schedule topic (#2394)
• Environmental Lead Investigation Services topic (#2398)
• Electronic Claim Submissions topic (#11217)
• Paper Claim Submission topic (#11218)

Allowable Procedure Codes

There are several Healthcare Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT) procedure codes that can be billed for each child tested. The allowable HCPCS and CPT procedure codes are listed below. Rate information for the codes can be found on the interactive maximum allowable fee schedules:

• Blood lead testing:
  • 99211 (Office or outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician or other qualified health care professional)
  • 36416 (Collection of capillary blood specimen [eg, finger, heel, ear stick])
  • 99000 (Handling and/or conveyance of specimen for transfer from the office to a laboratory)—Only use when a fingerstick blood specimen is mailed to a laboratory for analysis.
  • 83655 (Lead)—Only use when doing on-site blood lead testing using a point-of-care device.
• Environmental lead investigation services—T1029 (Comprehensive environmental lead investigation, not including laboratory analysis, per dwelling)
  • Modifier EP (Service provided as part of Medicaid early periodic screening diagnosis and treatment [EPSDT] program)—If procedure code T1029 is billed, the service must have the HealthCheck service modifier EP submitted in the primary modifier position.
  • Modifier TS (Follow-up service)—If procedure code T1029 is billed and the service represents a follow-up lead clearance investigation, modifier TS must also be submitted in the second modifier position.
• Lead poisoning education—T1002 (RN services, up to 15 minutes)—In-person or telehealth nursing visit must be completed by a registered nurse.