Lead toxicity screening required for all children enrolled in Washington Apple Health (Medicaid)

HCA Apple Health

PROVIDER ALERT

Lead toxicity screening is required for all Apple Health-enrolled children age 12 months and 24 months, regardless of lead exposure risk.

This is not a new requirement. This is a clarification of an existing requirement of the Centers for Medicare and Medicaid Services (CMS).

Washington State has requested a waiver from CMS to change from the current requirement of universal screening to targeted screening for children most at risk for elevated blood lead levels. Until CMS approves or denies that request, providers must follow CMS guidelines and screen all children at the required ages.

The required testing for blood lead poisoning in children should be billed using CPT code 83655. Either of the following diagnosis codes may be used:

  • Z77.011 contact with and (suspected) exposure to lead

OR

  •  Z13.88 special screening for other conditions, chemical poisoning, and other contamination

For additional information regarding screening in children, see the Early Periodic Screening, Diagnosis and Treatment (EPSDT) Program Provider Guide

CPT® codes and descriptions are copyright 2015 American Medical Association.