Lead Screenings (Medicaid and CHIP) 

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. In October 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 3.5 micrograms per deciliter to identify children with elevated blood levels.

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.

Blood Lead Level Update

The Department of Human Services (DHS) has issued this bulletin to inform providers enrolled in the Medical Assistance (MA) Program that they have updated the Blood Lead Reference Value to 3.5 micrograms per deciliter (μg/dL). In addition, universal blood lead toxicity testing should be completed by 12 months and at 24 months of age and is a required component of the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit. Providers are also required to test children between the ages of 36 and 72 months of age if they have not been previously tested for lead poisoning. Providers may test for blood lead using a capillary sample but must confirm an Elevated Blood Lead Level (EBLL) with a venous blood sample. Additionally, the MA Program provides coverage for blood lead testing of all MA enrolled children under 21 years of age at any time, if indicated by risk assessment, or for those children with a history or symptoms of lead exposure.

Lead Testing Kit Recall

Magellan Diagnostics, Inc. has expanded their product recall involving the LeadCare® blood test kits to include all its LeadCare II Blood Lead Test Kits, LeadCare Plus Blood Lead Test Kits, and LeadCare Ultra Blood Lead Test Kits because they could potentially underestimate blood lead levels when processing patient blood samples. Magellan Diagnostics has temporarily stopped shipments of LeadCare® test kits and has not issued a definitive date to resume shipments.

• Providers and healthcare organizations should discontinue the use of all LeadCare® II testing supply kits and quarantine the remaining inventory.
• Providers and healthcare organizations should identify and contact patients tested with recalled test kit lots. All results tested on impacted lots should be confirmed with an alternative lead testing option analyzed using a high complexity testing method, such as Inductively Coupled Plasma Mass Spectrometry (ICP-MS) or Graphite Furnace Atomic Absorption Spectroscopy (GFAAS) at a high complexity, CLIA-certified, reference laboratory.
• Please call DOH at 1-877-PA-HEALTH or your local health department if you have any questions.
• Review the Health Advisory from DHS.

Testing

All Health Partners (Medicaid) and KidzPartners (CHIP) members are required to have a lead test completed before 12 months and at 24 months. Current CHIP policy requires that all children ages one and two years old and all children ages three through six without a prior lead blood test have blood levels screened consistent with current Department of Health and CDC standards.

 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.”

Treatment Recommendations

Medical treatment is not recommended for children with blood lead levels lower than 45 micrograms per deciliter, according to CDC recommendations. 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

* The higher the BLL on the initial screening capillary test, the more urgent the need for confirmatory testing using a venous sample.

Recommended Schedule for Follow-Up Blood Lead Testing

* 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 health care 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.

For additional information, please visit the CDC's website.

Environmental Lead Investigation (ELI) Form

An ELI form is required for Health Partners members under the age of 21 with a blood lead screening result of at least 3.5 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 members. Forms can be found in the box below.

Resources

HPP encourages providers to check these online resources for more information about preventing lead exposure and removing lead paint from PA homes.

• Lead-Free Promise Project
• Strong Nation: Preventing Childhood Lead Exposure in Pennsylvania

More Information

Please contact county-based health departments and programs that offer resources, screening guidelines and other information.