CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

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State-mandated coverage for venipuncture and capillary specimen collection for lead screening for children under six as required by Rhode Island law; describes coverage, coding, and reimbursement instructions for commercial products (not applicable to Medicare Advantage).

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

Policysad

Policy CodePolicy N/A

Change Typeclarified

Effective DateSep 1, 2003

Next Review Date

Key ActionDocument that the specimen collection is for lead screening or lead-related diagnostic evaluation for a child under six years of age as required by Rhode Island statute and department regulations.

SourceLink

POLICY UPDATE CHANGES

Policy notes that prior authorization is not required.

2Specified Covered Procedure Codes

Children <6Primary Target Population

NoPrior Authorization Requirement

Coverage Summary

Rhode Island law (RIGL 23-24.6-9) mandates screening for lead poisoning and related diagnostic evaluations for children under six (6) years of age; these services, including confirmatory venous testing when indicated, are a covered health benefit and reimbursable.

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Venipuncture or capillary blood collection that is collected to be sent to a state-approved laboratory for lead screening is covered and separately reimbursable when reported with the -32 modifier for Commercial Products.

This state mandate applies to children under age 6 and generally does not apply to BlueCHiP for Medicare members; the mandate is for children who are not eligible for Medicare. Prior authorization is not required for venipuncture for lead screening.

Coverage at-a-glance

Specified Covered Procedure Codes2

Primary Target PopulationChildren <6

Prior Authorization RequirementPrior Authorization: No

Billing Codes

Covered Codes for Commercial Products (with -32 modifier)CPT/ModifierCovered

36415-32	Collection of venous blood by venipuncture (reported with -32 modifier)
36416-32	Collection of capillary blood specimen (eg, finger, heel, ear stick) (reported with -32 modifier)

Provider Actions & Billing Rules

Documentation Required

Age and clinical indication documentation

Document that the specimen collection is for lead screening or lead-related diagnostic evaluation for a child under six years of age as required by Rhode Island statute and department regulations.

Billing Rule

Modifier requirement for separate reimbursement

Report venipuncture and capillary blood collection codes with the -32 modifier to indicate separate reimbursement for Commercial Products.

36415-32
36416-32

Note

Prior Authorization not required

Prior Authorization is not required for venipuncture for lead screening. This was clarified in the policy.

Definitions & Background

The -32 modifier indicates that collection of blood by venipuncture or capillary collection (for example, finger, heel, or ear stick) is being billed separately for lead testing specimen collection; covered Commercial codes include 36415-32 (venous venipuncture) and 36416-32 (capillary collection).

Lead is particularly harmful to children younger than six years; screening is performed because even small amounts of lead can negatively affect development, cause learning disabilities, reduced IQ, behavioral problems, and other serious health effects.

Lead screening is conducted by a simple blood test that may be performed by finger prick (capillary) or venipuncture; if a stick (capillary) test shows a significant elevation, a confirmatory venous blood sample is generally obtained.

Medicare Applicability

Informational: Rhode Island-mandated benefits generally do not apply to BlueCHiP for Medicare members; the statutory mandate targets children under age 6 who are not eligible for Medicare.

Revision History

clarification