OAR 410-151-0040: Lead Screening

(1) All children enrolled in the Oregon Health Plan, including Fee-for-Service and MCEs, must have blood lead screening tests. Children with Medical Assistance Program coverage must have blood lead screening tests at age 12 months and 24 months. Any child between ages 24 and 72 months with no record of a previous blood lead screening test must receive one. Completion of a risk assessment questionnaire does not meet the lead screening requirement for children under Medicaid. (2) Method of Blood Collection: A single venous or capillary blood draw is acceptable for the blood lead screening test. A capillary blood lead level greater than or equal to 3.5 micrograms per deciliter must be confirmed with either a venous draw or a second capillary draw within 12 weeks. (3) Blood lead levels greater than or equal to 3.5 micrograms per deciliter from a venous draw or two capillary blood lead tests greater than or equal to 3.5 micrograms per deciliter drawn within 12 weeks of each other in children under 18 years of age and pregnant or lactating women are defined as cases and initiate case management by the local public health authority. See the definition of “Blood lead level at or above the blood lead reference value” in OAR 333-017-0000. (4) Billing of laboratory services is covered in: OAR 410-130-0680. (a) For the collection of blood, use CPT 36415 for a venipuncture sample or CPT 36416 for capillary puncture samples. (b) To bill for venipuncture or capillary blood lead screening, use Current Procedural Terminology (CPT) code 83655. (5) Health care providers shall report all cases or suspected cases when blood lead levels are at or above the blood lead reference value to local public health authority within one working day and within seven days when any blood lead level tests are performed including the result. See OAR 333-018-0015(3)(c)(A); OAR 333-018-0015(3)(d) (6) All children, pregnant and lactating women with lead poisoning are eligible to receive follow up case management services. See OAR 333-019-0000 and Oregon Health Authority Public Health Division’s Oregon Lead Poisoning Investigative Guidelines at: https://www.oregon.gov/oha/PH/HealthyEnvironments/HealthyNeighborhoods/LeadPoisoning/CountyHealthDepartments/Documents/Diseaseguidelines.pdf . (7) The local public health authorities are eligible for investigation reimbursements. To bill for comprehensive lead investigation, use HCPCS code T1029. Payment for code T1029 includes the home investigation and any follow-up case management services provided after the home investigation is completed. The Authority limits reimbursement of T1029 to one time per dwelling. For clients enrolled in Fee-for-Service, the service is payable by the Authority for dates of service through September 30, 2020. Effective October 1, 2020 for members enrolled in managed care plans, the service is payable by the managed care plan.