Early and Periodic Screening and Diagnostic Treatment (EPSDT) is a valuable component of patient care for children under 21. Routine visits can identify potential medical concerns and also help develop the important relationships between children, their caregivers and the primary care provider (PCP).
The Pennsylvania Department of Human Services (DHS) requires all Medical Assistance providers to perform screenings that meet national standards recognized by the American Academy of Pediatrics (AAP). Refer to the recent DHS bulletins for the latest updates:
Refer to the current EPSDT Periodicity Schedule and Coding Matrix for guidelines.
Lead Screening—for Medicaid and CHIP kids
Lead exposure, especially among young children, continues to be a significant part of the national discussion regarding health issues. According to the Centers for Disease Control (CDC), even low levels of lead in blood have been shown to affect a child’s IQ, their ability to pay attention, and academic achievement. As recently as 2012, children with a blood lead level of 10 micrograms per deciliter of blood (μg/dL) or greater were considered to be a concern. However, the CDC’s current guidelines now reference a blood level of only 5 micrograms per deciliter to identify children with elevated blood levels1.
Lead testing is especially vital in Philadelphia County, which is designated as a “high blood lead area.” For patients in Philadelphia County with an abnormal blood lead level, refer them for an Environmental Lead Investigation (ELI) by completing and faxing a form to the City of Philadelphia.
Medical Treatment Recommendations per the CDC
Medical treatment is not recommended for children with blood lead levels lower than 45 micrograms per deciliter. However, parents should learn about possible sources of lead exposure and attempt to determine if one or more sources of lead are present in their home. Parents then can follow the CDC’s recommendations to control children’s exposure to lead.
- Children can be given a blood test to measure the level of lead in their blood. These tests are covered by Medicaid and most private health insurance.
- Chelation therapy should be considered for any child that has a blood lead test result greater than or equal to 45 micrograms per deciliter.
Recommended Schedule for Obtaining a Confirmatory Venous Sample
Blood Lead Level (μg/dL)
Time to Confirmation Testing
|10-44||1 week-1 month*|
|≥70||Urgently as emergency test|
*The higher the BLL on the screening test, the more urgent the need for confirmatory testing.
Schedule for Follow-Up Blood Lead Testing
Venous Blood Lead Levels (µg/dL)
Early Follow Up Testing (2-4 tests after Identification)
Later Follow Up Testing after BLL Declining
|≥5–9||3 months*||6-9 months|
|10-19||1-3 months*||3-6 months|
|20-24||1-3 months*||1-3 months|
|25-44||2 weeks - 1 month||1 month|
|≥45||As soon as possible||As soon as possible|
*Seasonal variation of BLLs exists and may be more apparent in colder climate areas. Greater exposure in the summer months may necessitate more frequent follow ups.
Some case managers or healthcare providers may choose to repeat blood lead tests on all new patients within a month to ensure that their BLL level is not rising more quickly than anticipated.
An ELI form is required for Health Partners (Medicaid) members under the age of 21 with a blood lead screening result of at least 5 μg/dL, and where there are environmental influences for lead contamination. The order for an ELI must include a primary diagnosis code of toxic effect of lead and its components. It is free for Health Partners (Medicaid) members.
All Health Partners (Medicaid) and KidzPartners (CHIP) members are required to have a lead test completed before 12 months and at 24 months. In the event that testing is not completed during these timeframes, we urge your office to perform testing at the next Well Child Visit.
Testing can be conducted in either your office or at a Quest Diagnostics Drawing Station. When you conduct an ‘In-Office Lab Draw’ lead screening test, please note that you should submit CPT code 83655. If the testing occurs at a Quest Diagnostics Drawing Station, be sure to provide a prescription to the parent/guardian to enable them to visit any Quest Diagnostics location. Find the closest testing facility by utilizing the Provider Directory and searching for “Quest Diagnostics.”
Your office can order Filter Paper supply kits by completing a Quest Diagnostics order form.
For more information
Please contact county-based health departments and programs that offer resources, screening guidelines and other information.
|Chester||Chester County Health Department||610-344-6252|
|Montgomery||Montgomery County Health Department||610-970-5040|
|Philadelphia||Childhood Lead Poisoning Prevention Program||215-685-2788|