Required Lead Blood Test Reimbursable

Safeguarding Children Is Easier Than You Think

Pennsylvania’s Children’s Health Insurance Program (CHIP) requires that all members ages 9 months to 2 years have at least one lead blood test that can be performed during the routine wellness and developmental screening visits. These are preventive, reimbursable benefits with no out-of-pocket costs for these members.

Did you know?

Completing the lead blood test is easy! It can be completed with the routine hemoglobin test performed at 12 months for anemia, per Bright Futures™. Even better news: No blood draw is required. Simply complete one finger stick for both the hemoglobin and lead tests. Finally, the lead blood test and developmental screening test are reimbursable if submitted using procedure codes 83655 and 96110, respectively.

We understand that since symptoms may not be readily identifiable in infants and those under 1 year of age, parents may be hesitant to request or permit the test, even if you discuss it with them. However, lead poisoning is a serious matter, with potential mental and physical symptoms not showing up until several years later. These symptoms, which may be more difficult to treat later in the child’s life, include:

Developmental delay (testing discussed below)
Learning difficulties
Seizures
Hearing loss
Irritability
Weight loss
Sluggishness and fatigue
Loss of appetite
Abdominal pain
Vomiting

Next, a developmental screening is also recommended. It can assist in early detection of autism, learning disabilities, and developmental delays. As stated, this test is also reimbursable, with no out-of-pocket member costs, if billed using procedure code 96110.

Quality care — tying the testing together

Lead blood test: Lead poisoning isn’t simply a paint-related issue that occurs only from old houses. Lead poisoning can come from other places where children play, like around old water pipes, soil that is tracked into the house, or even from the child’s favorite toys.
Developmental screenings: Subsequently, the Centers for Disease Control and Prevention (CDC) recently encouraged pediatricians and PCPs to follow American Academy of Pediatrics guidelines for screening children 3 years of age and younger for developmental disabilities. This occurred due to 2014 findings that 17 out of every 20 children in the Autism and Developmental Disability Monitoring Network had a developmental concern by the age of 3. Of this number, only eight of every 20 children had undergone a developmental evaluation by that same age.

Early screenings are among the best resources to rule out or expedite treatment if an issue is identified. As mentioned, there is minimized pain since no secondary blood draw is required for the lead blood test. Highmark does understand parents may choose to shelter their children from painful situations if they don’t see obvious signs of health-related concerns.

For this reason, Highmark is providing the following CDC web resources. This information may prove to be beneficial when discussing these topics with parents during testing visits and/or in preparation for upcoming appointments. Parents who understand potential health concerns are better equipped to make informed decisions related to the welfare of their children.

Highmark appreciates the quality care you provide to our members, your patients. Working together, we can achieve more effective patient outcomes.

Source:
Healio. May 8, 2018. “CDC: PCPs need to conduct more pediatric development screenings.” healio.com/family-medicine/pediatrics/news/online/%7B0522d7f8-3a91-4fb2-b281-e581ab3b7b1e%7D/cdc-pcps-need-to-conduct-more-pediatric-development-screenings