Guidelines for On-Site Blood Lead Testing

Effective immediately, providers may be reimbursed for on-site blood lead testing using LeadCare II or similar Clinical Laboratory Improvement Amendment (CLIA)-waived instruments if the following guidelines are met:

• Providers are successfully participating in the proficiency testing (PT) program as administered by the Wisconsin State Lab of Hygiene (WSLH) or another Centers for Medicare and Medicaid Services-approved proficiency testing program.
• Providers must report all lead testing results, regardless of the lead level, to the Wisconsin Childhood Lead Poisoning Prevention Program (WCLPPP).

To be reimbursed for the on-site blood lead test, providers should indicate on the claim procedure code 83655 (Lead). Procedure code 99000 (Handling and/or conveyance of specimen for transfer from the physician’s office to a laboratory) is not separately reimbursable when procedure code 83655 is billed. Providers are eligible to be reimbursed for an appropriate office visit.

On-site blood lead testing is covered under these guidelines for both the BadgerCare Plus Standard Plan and the Benchmark Plan. There is no copayment for on-site blood lead testing in either plan.

Proficiency Testing

Reimbursement for on-site blood lead testing of BadgerCare Plus members is conditional on successful participation in the WSLH or other approved PT program. The WSLH program is currently available at no cost to participants. Performance must be consistent with 1988 CLIA regulatory requirements, regardless of the test method employed.

The CLIA regulations require three test events each year, each consisting of five test samples. Labs must obtain an 80 percent or better score for satisfactory performance in an individual event and are required to attain satisfactory event performance in two of every three consecutive events. For additional information about PT, contact the WSLH at (608) 224‑6252.

Reporting of Results

Providers are required to report all on-site blood lead test results to the WCLPPP, regardless of the lead level. For reporting requirements, refer to HFS 181, Wis. Admin. Code. Refer to the Attachment of this BadgerCare Plus Update for the Blood Lead Lab Reporting form, DPH 7142 (01/07). To establish a mechanism for reporting results, providers may call the WCLPPP at (608) 266‑5817 and ask for the data manager.

Attachment — Blood Lead Lab Reporting (PDF, 79 KB)