CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Newborn Metabolic, Endocrine and Hemoglobinopathy and Newborn Hearing Loss Screening Programs Mandate

Governs Rhode Island state-mandated coverage and reimbursement requirements for newborn metabolic, endocrine, hemoglobinopathy, and newborn hearing screening programs for insured newborns and responsible providers/facilities.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyNewborn Metabolic, Endocrine and Hemoglobinopathy and Newborn Hearing Loss Screening Programs Mandate

Policy CodePolicy N/A

Change TypeNo material change

Effective DateJul 1, 2006

Next Review DateAug 8, 2025

Key ActionUse State-provided filter specimen slips and submit newborn screening reports and confirmed diagnoses to the Department per reporting requirements.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

All newbornsNewborns required to be screened

Covered benefitCoverage status

84999-32DOH lab billing code

90 daysReport timeframe

Coverage Criteria and Mandates

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Mandated Screening Coverage and Obligations

Covered as a mandated state benefit with specific provider and laboratory obligations

Mandatory screening: The attending physician, nurse practitioner, physician assistant and/or midwife shall cause the newborn to be screened for the listed conditions unless parents object on religious grounds.

Religious exemption per R.I. Gen. Laws § 23-13-14 applies.

Laboratory reporting: All newborn screening test reports must be submitted to the attending physician and the Department and shall include actual values and reference ranges used for each disorder.

Confirmed diagnoses and associated data (diagnostic test type, treatment type, and other information requested by the Director) must be reported to the Department within 90 days of confirmation.

Materials and laboratory approval: The Department shall provide filter specimen slips to facilities and to attending clinicians for out‑of‑facility births; specimen slips shall contain instructions for collection and submission.

Laboratories performing newborn screening tests must be approved by the Director; program services are subject to the established fee schedule.

Payment responsibility: The Newborn Screening Program is a covered benefit reimbursable by all health insurers except limited supplemental policies; the Rhode Island Department of Human Services will pay when the patient is eligible for Medical Assistance.

In absence of a third‑party payor or sufficient insurance information, hospitals or other birth facilities (and attending providers for out‑of‑facility births) must pay costs but may bill the patient; self‑funded groups may opt out and Medicare Advantage may not be subject to state mandates.

Mandated newborn screening coverage

Covered when ALL of the following statutory and program conditions are met:

Statutory screening requirements: Newborns in Rhode Island shall be screened for hearing impairments per R.I. Gen. Laws § 23-13-13 and for metabolic, endocrine, and hemoglobinopathy disorders as mandated by state program guidance.

Parents may object to hearing tests on religious grounds; such tests shall not be performed.

Coverage and payer responsibilities: The Newborn Screening Program is a covered benefit reimbursable by all health insurers, except supplemental policies that only provide coverage for specific diseases, hospital indemnity, Medicare supplement, or other supplemental policies; the Rhode Island Department of Human Services will pay when the patient is eligible for Medical Assistance.

In the absence of a third‑party payor or sufficient insurance information, costs (including the coordination fee) shall be paid by the hospital or other health care facility where the birth occurred, or by attending clinicians for out‑of‑facility births; facilities/providers may bill the patient directly.

Specimen processing and billing: Hospitals draw blood and forward samples to the Department of Health Laboratory for testing; the Department of Health Laboratory submits claims under unlisted code 84999-32 representing all tests performed by the DOH laboratory.

The Rhode Island Newborn Screening Program is designated as a mandated state-covered benefit reimbursable by health insurers; however, applicability to some payer types is limited. Medicare Advantage plans are not subject to the State mandate unless specifically noted elsewhere in the policy, and self‑funded employer groups may elect not to follow state mandates. When the patient is eligible for Medical Assistance, the Rhode Island Department of Human Services will pay for the Newborn Screening Program. If no third‑party payer or sufficient insurance information exists, the hospital or birth facility — or the attending providers for out‑of‑facility births — are responsible for payment but may bill the patient directly.

Not all insurance products are required to reimburse the Newborn Screening Program. Supplemental policies that only provide coverage for specific diseases, hospital indemnity, Medicare supplement, or other supplemental policies are excluded from the state mandate to reimburse screening. Benefits also vary by contract; providers should confirm coverage in the member’s Benefit Booklet, Evidence of Coverage, or Subscriber Agreement because group‑level or contract exclusions (including some self‑funded plans) can result in non‑coverage.

Provider Responsibilities, Billing, and Reporting

Documentation Required

Reporting requirements — Laboratory and provider obligations

All reports of newborn screening tests performed by a laboratory must be submitted to the attending physician and to the Rhode Island Department of Health. Reports shall include the actual measured value and the reference ranges used for each disorder.

Submit confirmed newborn screening diagnoses, diagnostic test type, treatment type, and any additional information required by the Director for surveillance or program needs.
Confirmed cases and required data must be submitted to the Department's Newborn Screening Program within 90 days of confirmation.

Billing Rule

Reporting and billing responsibility

The hospital or health care facility where the birth occurred is responsible for drawing and forwarding newborn screening specimens to the Department of Health Laboratory. If there is no third-party payor or sufficient insurance information for billing and collection, the costs for the Newborn Screening Program (including coordination fees) shall be paid by the hospital or facility; hospitals/facilities may bill the patient directly. The Rhode Island Department of Human Services will pay when the patient is eligible for Medical Assistance.

Hospitals forward samples to DOH Laboratory for testing.
DOH Laboratory submits claims under unlisted code 84999-32 representing all tests.
In the absence of insurance or billing information, facility/provider bears program costs; DOH/DHS pays when patient is eligible for Medical Assistance.

Note

Specimen collection materials

The Department shall provide filter specimen slips to health care facilities where births occur and to clinicians attending out-of-facility births. The slips include instructions for specimen collection and submission to the contracted laboratory.

Use the State-provided filter specimen slips for collection and submission.
Ensure specimens are collected per the instructions on the slips and forwarded to the Department-contracted laboratory.

Note

Program scope and statutory requirements

Newborn hearing screening is statutorily required for all newborns in Rhode Island per R.I. Gen. Laws § 23-13-13 and related procedures, but parents may opt out on religious grounds. Labs performing newborn screening must be approved by the Director.

Follow the "Procedures for Evaluating Newborn Infants for Hearing Impairments" available at www.health.ri.gov/programs/hearingassessment/.
Obtain and maintain Director approval for laboratories performing mandated newborn screening tests.

Background and Purpose

Newborn screening aims to identify conditions not apparent at birth so early interventions can prevent death or irreversible disability. Rhode Island’s program screens for a broad panel of metabolic, endocrine, hemoglobinopathy and other disorders (for example, amino acid disorders, organic acid disorders, fatty acid oxidation disorders, hemoglobin traits and disorders, congenital hypothyroidism and congenital adrenal hyperplasia, lysosomal storage disorders, spinal muscular atrophy, biotinidase deficiency, cystic fibrosis, classical galactosemia, and severe combined immunodeficiency). In addition, hearing screening is required for all newborns under R.I. Gen. Laws § 23-13-13 (with a parental religious exemption permitted). Screening is typically performed in the first days of life using heel‑prick blood specimens and newborn hearing screens prior to discharge to enable prompt diagnostic follow‑up and treatment when indicated.

Definitions and Tested Conditions

Screened conditions

Amino acid disordersIncluded (see Rhode Island list) — examples include conditions detected via metabolic screening

Organic acid metabolism disordersBeta-Ketothiolase deficiency; Glutaric Acidemia Type I; Hydroxymethylglutaric aciduria (HMG-CoA lyase deficiency); Isovaleric Acidemia; 3-Methylcrotonyl-CoA Carboxylase deficiency; Methylmalonic Acidemia (cbIA/cbIB and mutase deficiency); Multiple carboxylase deficiency; Propionic Acidemia

Fatty acid oxidation disordersCarnitine uptake defect; LCHAD; MCHAD; VLCAD; Trifunctional protein deficiency

Hemoglobin traits and disordersSickle cell anemia; Hemoglobin S/Beta-Thalassemia; Hemoglobin S/C disease; other disorders detectable by hemoglobin electrophoresis

Endocrine disordersCongenital hypothyroidism (CH); Congenital adrenal hyperplasia (CAH)

Lysosomal storage and neuromuscular disorders and other conditionsGlycogen storage disease type II (Pompe); MPS I; Spinal muscular atrophy (SMA); Biotinidase deficiency; Cystic fibrosis; Classical galactosemia (GALT); SCID; Critical congenital heart disease; X-linked adrenoleukodystrophy (X-ALD)

DOH laboratory unlisted billing code

Unlisted laboratory codeHCPCS unlisted code 84999-32 — represents all newborn metabolic tests performed by the Department of Health Laboratory

OpenPayer

Newborn Metabolic, Endocrine and Hemoglobinopathy and Newborn Hearing Loss Screening Programs Mandate

Coverage Criteria and Mandates

Billing and Coding

Provider Responsibilities, Billing, and Reporting

Background and Purpose

Definitions and Tested Conditions