June 01, 2022

Wisconsin Medicaid: Requirements and best practices for lead screening in children

As you know, protecting children from exposure to lead is important for a child’s health and well-being. According to the Centers for Disease Control and Prevention (CDC), even low levels of lead in blood can affect a child’s intelligence, ability to pay attention and academic achievement.1

We want to support your efforts to help ensure your pediatric patients who are UnitedHealthcare Community Plan members are receiving blood lead level tests at the required ages.

Here are state-mandated requirements for lead testing and best practices for you and your staff:

Lead testing requirements
The Wisconsin Department of Health Services (DHS) requires all children enrolled in Medicaid to receive a blood lead level test at:

  • Age 12 months
  • Age 24 months
  • Between ages 3 and 5 for children who have never been tested before

All blood lead tests must be reported to the state. For more information, see DHS guidelines for lead testing and reporting.

Best practices for lead testing
When a child presents for an office visit, Wisconsin DHS recommends asking their parent or guardian the following questions to help assess the child’s risk for lead exposure. If the answer to any of these questions is “yes”, the child is at risk for lead exposure and should be tested:

  1. Does the child now live in or visit a house or building built before 1950, or have they ever in the past? (Include places such as day care, homes of friends, grandparents or other relatives) 
  2. Does the child now live in or visit a house or building built before 1978 with recent or ongoing renovations, or have they ever in the past? (Include places such as day care, homes of friends, grandparents or other relatives) 
  3. Does the child have a brother, sister or playmate who has/had lead poisoning? 
  4. Is the child enrolled in Medicaid or WIC? 

We also recommend these additional best practices for lead testing:

  • Use your electronic medical record (EMR) lead risk assessment tool. If you answer “yes” to any of the questions, a capillary finger stick test or venous blood test is required
  • Test during office visits
  • Consider using the LeadCare® II point-of-care test, developed by the CDC, for in-office screening
  • Use the correct CPT® codes when submitting claims
    • Blood lead screening: 83655
    • Collection of capillary blood specimen: 36416
    • If sending the test to a lab by mail or transport, use CPT codes 83655 (lead), 36416 (collection) and 99000 (lab handling fee)

Learn more
You can find more information about requirements and best practices through the Wisconsin Childhood Lead Poisoning Prevention Program.

Questions?

  • UnitedHealthcare Community Plan: Call Provider Services at 877-842-3210
  • Wisconsin Department of Health Services Childhood Lead Poisoning Prevention Program: 

1Health Effects of Lead Exposure, CDC
CPT® is a registered trademark of the American Medical Association

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