Childhood blood lead screening
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Defines MemorialCare Select Health Plan expectations for screening young children (6 months to 6 years) for elevated blood lead levels and related documentation; applies to physicians, participating physician groups, hospitals, and ancillary providers (with Medi-Cal county details noted).
No material clinical or coverage changes in this revision.
When Screening Is Covered / Indicated
When screening is required or indicated
Covered when ANY of the following conditions occur
The policy lists no explicit exclusions for childhood blood lead screening. If a parent or caregiver withholds consent for testing, providers must either obtain a signed statement of voluntary refusal or document why the signed statement was not obtained (for example, parent declined to sign or care was delivered via telehealth). Maintain this documentation in the child’s medical record to satisfy the DHCS APL 20-016 requirements.
This policy does not designate any services as not medically necessary. Instead, it specifies conditions under which screening is required or indicated and requires documentation when testing is not performed for any reason.
Billing and Diagnosis Codes
| 83655 | Lead test |
| Z13.88 | Encounter for screening for disorder due to exposure to contaminants |
Provider Responsibilities, Documentation, and Billing
Billing codes required for reporting lead screening
Use CPT code 83655 for the lead test and ICD-10 code Z13.88 for the screening encounter when billing so the screening is recorded.
No step therapy; follow recommended screening times
There is no step therapy requirement. Perform blood lead screening at the recommended routine ages and whenever risk or lack of documented prior screening is present.
- Perform screening at 12 months and at 24 months of age.
- Order or perform screening when you become aware there is no documented evidence of screening at 12 months or thereafter and for ages 24–72 months.
- Perform screening any time a change in circumstances, in your professional judgment, puts the child at risk.
- Perform screening if requested by the parent or guardian.
Obtain signed refusal or document why refusal statement not obtained
If a child's parent or caregiver withholds consent for a lead test, obtain a signed statement of voluntary refusal or document why the signed statement was not obtained (for example, parent declined to sign or care was via telehealth).
Document reasons when screening not performed
Document the reason(s) for not performing a blood lead screening test in the child's medical record.
Reporting and documentation noncompliance risk
Failure to document the reasons for not performing a blood lead screening test or failure to report lead test results to the Childhood Lead Poisoning Prevention Branch (CLPBB) could lead to noncompliance with stated requirements.
- Report lead test results to the CLPBB as required.
- Maintain documentation of refusal or reasons for not testing in the medical record to avoid noncompliance.
Periodic Health Assessment (PHA)
Clinical Background
Per CDC and California guidance cited in this policy, even low levels of lead exposure in young children can cause learning, developmental, and behavioral problems, including reduced IQ, damage to the brain and nervous system, and speech and hearing impairment. Children are particularly vulnerable from the time they begin to crawl until 72 months of age. The policy emphasizes that screening and preventive guidance during well-child visits can mitigate these risks.
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