Find policies, billing codes, payers, states, and providers
Pediatric Preventive Screening
Customize your policy alerts
Sign up for blue cross blue shield - louisiana Policy AHS - G2042 - Pediatric Preventive Screening alerts
Get alerted when Policy AHS - G2042 - Pediatric Preventive Screening changes without checking for updates manually.
Monitor payer policy activity
Defines coverage policy for laboratory-based preventive screening tests in individuals newborn through age 18 (excluding newborn genetic disorder screening) and describes indications, recommended timing, and references to related testing policies. Affects pediatric patients and providers ordering preventive screening tests.
Lead screening criteria were edited to limit screening to children at increased risk, with specified testing frequencies (monthly at 6, 9, 12 months; annually from ages 2–6).
Hepatitis B, chlamydia/gonorrhea/syphilis, and HIV screening coverage were moved to separate policies (G2036, G2157, M2116) and related CPT codes removed from this policy.
CPT codes 83020 and 83021 were added for sickle cell testing; CPT 85660 was removed.
Coverage Criteria for Pediatric Preventive Screening
Covered preventive screening tests
Covered when criteria below are met:
References RUSP and state mandates.
Refer to Note 1 for CDC-defined risk factors.
Refer to Note 2 for AAP iron deficiency risk factors.
Refer to Note 3 for TB risk factors.
AAP/Bright Futures provide additional periodicity guidance.
Lead screening (increased-risk)
Covered when ALL of the following are met (lead screening specific edit noted in revision history):
See Note 1 for high-risk definitions; CDC BLRV = 3.5 µg/dL
Lead screening (high risk)
Covered when ALL of the following are met
See Note 1 for definition of increased risk
This policy covers laboratory-based preventive screening tests performed on individuals from newborn through 18 years of age, but it explicitly excludes newborn genetic disorder screening. Newborn genetic disorder screening (state-mandated RUSP-type panels) is governed by applicable federal and state law and is not within the scope of this medical policy. Providers should follow state newborn screening requirements and referenced newborn screening guidance for coverage determinations.
Coverage for screening tests for HIV, Hepatitis B, chlamydia, gonorrhea, and syphilis has been relocated out of this pediatric preventive screening policy to disease-specific policies. Refer to the related policies listed in the document (for example, G2036 for Hepatitis testing, G2157 for diagnostic testing of common sexually transmitted infections, and M2116 for HIV) for coverage rules, coding, and billing guidance for these infections.
As part of policy reorganization, coverage statements for certain infectious disease screening (including Hepatitis B, chlamydia, gonorrhea, syphilis, and HIV) were moved to discrete, disease-specific policies. These tests are no longer governed by this preventive screening policy; providers should consult the cited disease-specific policies for applicable coverage criteria and appropriate CPT coding.
The USPSTF has concluded that the evidence is insufficient to recommend universal screening for lipid disorders in children and adolescents ≤20 years of age. This policy aligns with those recommendations and references AAP/Bright Futures guidance for age-based, risk-targeted lipid screening rather than universal population screening.
The USPSTF found the current evidence insufficient to support routine dyslipidemia and iron deficiency screening in certain young children and has stated insufficient evidence to recommend universal lead screening in asymptomatic children ages 1–5 years. Where evidence is insufficient, this policy endorses targeted, risk-based screening per AAP/Bright Futures and CDC guidance rather than routine universal testing.
Sickledex and similar hemoglobin solubility assays (historically coded as 85660) are noted as unreliable in newborns because high levels of fetal hemoglobin (hemoglobin F) interfere with assay performance. The policy removal of code 85660 reflects this limitation; hemoglobin fractionation/quantitation using the appropriate CPT codes (for example, 83020 and 83021) should be used for newborn sickle cell testing.
Procedure Codes and Coding Notes
| 80061 | Lipid panel |
| 82247 | Bilirubin; total |
| 82248 | Bilirubin; direct |
| 82465 | Cholesterol, serum or whole blood, total |
| 83020 | Hemoglobin fractionation and quantitation; electrophoresis (eg, A2, S, C, and/or F) |
| 83021 | Hemoglobin fractionation and quantitation; chromatography (eg, A2, S, C, and/or F) |
| 83655 | Lead |
| 83718 | Lipoprotein, direct measurement; high density cholesterol (HDL cholesterol) |
| 84439 | Thyroxine; free |
| 84443 | Thyroid stimulating hormone (TSH) |
Provider Responsibilities and Billing Actions
No prior authorization required in this policy segment
No prior authorization requirement is stated in this policy segment. The policy explicitly notes that “No explicit prior authorization requirements are stated in this portion of the policy.” Providers should follow member benefit determinations at the time of service.
Procedure codes listed for reference — use policy-listed codes
Procedure and CPT/HCPCS codes listed in the policy are provided for reference and may be revised; providers should use the codes listed when submitting claims and be aware codes may move between policies.
Prior auth absent; ensure correct CPT use and follow disease‑specific policies
No explicit prior authorization is required, but coding changes and repositioning of tests require correct CPT usage and following disease‑specific policies for coverage rules (e.g., HIV and Hepatitis B moved to other policies).
- Policy revision notes: “No explicit prior authorization requirements are stated in these chunks; coding changes require correct CPT usage and referral to disease‑specific policies for coverage rules.”
- See revision history directing HIV and Hepatitis B screening to separate policies (G2157, G2036, M2116).
No step therapy; follow AAP/Bright Futures and CDC guidance for sequencing
Step therapy/required sequencing is not applicable in this document portion. Screening frequency and sequencing should follow AAP/Bright Futures and CDC guidance (e.g., targeted lead testing when risk assessment is positive).
- AAP/Bright Futures periodicity schedule referenced for timing and frequency.
- AAP recommends risk assessment and targeted lead testing rather than universal lead screening except in high‑prevalence areas.
Document age and specific risk factors when ordering screening
Document patient age and risk factors when ordering screening. The policy requires following Bright Futures/AAP periodicity schedules and documenting age and relevant risk factors (for example, lead, TB, dyslipidemia risk) to support targeted testing.
- Policy: “Providers should follow recommended periodicity schedules (Bright Futures/AAP) and document age, risk factors (e.g., lead, TB, dyslipidemia risk), and indication for targeted screening per AAP/CDC guidance.”
- Lead screening coverage is limited to those with increased risk and specific age‑based frequencies (see lead frequency callout).
Document specific CPT/HCPCS codes on claims
Include the specific CPT/HCPCS procedure codes on claims and supporting documentation. The policy lists included and removed codes and instructs providers to document the specific codes when submitting claims.
Use updated CPT coding; do not use removed codes
Use current, updated CPT codes and do not bill with codes the policy removed. The revision history added codes (e.g., 86481, 83020, 83021) and removed multiple codes (including 85660 and various HIV/Hep B codes); providers must code using the updated list and follow referenced policies for moved tests.
Coverage depends on member benefits and state RUSP compliance
Coverage depends on the patient’s benefits at the time of request; newborn screening panels meet coverage when they follow applicable federal and state law recommendations (RUSP/state mandates).
- Policy: “Application of coverage criteria is dependent upon an individual's benefit coverage at the time of the request.”
- “When it follows all applicable federal and state law recommendations, a newborn screening panel MEETS COVERAGE CRITERIA.”
Bill moved infection screenings under the referenced disease‑specific policies
Tests moved to other policies must be billed per those policies. The revision history states coverage for HIV, Hepatitis B, chlamydia, gonorrhea, and syphilis screening was moved to G2157, G2036, and M2116; billing these tests under this policy may lead to denial.
- Revision history: coverage moved to G2036 (Hepatitis), G2157 (STIs), and M2116 (HIV).
- Policy note: “Off‑Cycle Review: Due to policy reorganization, coverage on screening for Hepatitis B… was moved to G2036… and coverage on HIV screening… was moved to M2116.”
Denial risk if removed or relocated codes/tests are billed under this policy
Claims risk denial if submitted with codes removed from this policy or if tests moved to other policies are billed under this policy. The policy warns that claims submitted under this policy for those tests may be denied unless billed per the referenced policies.
- “Removed multiple HIV and Hepatitis B CPT codes from coverage lists and redirected HIV and Hep B coverage criteria to other policies.”
- “Coverage for certain infectious disease screenings… was moved to other policies; billing those tests under this policy may be denied per coding updates and policy references.”
Background and Rationale
Preventive screening in pediatrics aims to protect and maintain health across populations by detecting conditions early and enabling timely intervention. Recommendations differ by age group—newborns, infants, children, and adolescents—because the balance of benefits and harms varies with age and condition. This policy uses AAP/Bright Futures periodicity guidance for age-based screening and recognizes that certain newborn screens are state-mandated, while other screenings (for example, targeted lead testing or age-/risk-based lipid screening) follow AAP and CDC risk-based recommendations. Recent revision history also operationalizes targeted lead screening frequency for children at increased risk.
Definitions and Reference Terms
Policy Revision History
Policy reviewed and updated (effective 2026-08-01); literature review noted and document status set to Modified with prior revisions reflected.
CC5 edited to limit lead screening to children at increased risk and to specify testing frequencies: one test per month at 6, 9, and 12 months, and one test per year from ages 2–6; CPT code 86481 added and CPT codes 86850, 87555, 87556, and 0257U removed.
Off-cycle review: coverage for Hepatitis B, chlamydia, gonorrhea, syphilis, and HIV screening was moved to disease-specific policies (G2036, G2157, M2116), with related CPT codes removed from this policy.
CPT coding updates: multiple HIV and Hepatitis B CPT codes removed; CPT 85660 (sickledex/solubility assay) removed as unreliable in newborns and CPTs 83020 and 83021 added for sickle cell testing; clarifying edits made across coverage criteria.
CDC updated the blood lead reference value (BLRV) from 5 µg/dL to 3.5 µg/dL, referenced in policy notes and risk definitions.
OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.