Lead Screening in Children – Exploratory Measure Tip Sheet
The percentage of children 2 years of age who had one or more capillary or venous lead blood test for lead poisoning by their second birthday.
This is an exploratory measure; there is no payment for 2021 and 2022. For additional information, refer to the 2021 and 2022 CBI Technical Specifications.
- Exposure to lead in children can cause damage to the brain and other vital organs, as well as intellectual and behavioral deficits.
- Research suggests there is no safe blood lead level (BLL) and its effects are irreversible. Chelating agents that intend to remove lead may reduce fatality rates but have not been demonstrated to improve IQ or behavioral consequences of lead exposure. See CDC’s Lead Poisoning Prevention web page for more information.
- Children exposed to lead have no obvious symptoms; as a result, lead poisoning often goes unrecognized.
- Elevated blood lead levels primarily affect children with a lower socioeconomic status and from minority communities because of the increased risk of housing-related exposure (U.S. Preventive Services Task Force).
California law requires a blood lead test for Medi-Cal members at 12 and 24 months of age and requires health care providers performing blood lead analysis to report all results to the California Department of Public Health (CDPH) Childhood Lead Poisoning Prevention Branch. Provides should perform a catch-up test for children 24 months to 6 years who were not tested at 12 and 24 months.
DHCS also requires that providers give oral or written anticipatory guidance to parents/guardians of a child at each periodic health assessment from 6 to 72 months, which includes information related to the harms of lead.
Network providers are not required to perform a blood lead screening test if either of the following applies:
- In the professional judgment of the provider, the risk of screening poses a greater risk to the child member’s health than the risk of lead poisoning. This must be documented in the medical record.
- If a parent/guardian or other person with legal authority withholds consent to the screening, the provider must obtain a signed statement of voluntary refusal or document the reason for not obtaining a signed statement in the child’s medical record (Example: When services are provided via telehealth modality or party declines to sign).
CPT Code: 83655
Data for this measure will be collected using claims and DHCS Fee-for-Service encounter claims. To find gaps in data:
- Run a report from your Electronic Health Record (EHR) system; or.
- Manually compile patient data (Example: Download the Lead Screening in Children quality report or your Care-Based Incentives Measure Details report on the Provider Portal and compare to your EHR/paper charts).
- Conduct an environmental assessment prior to blood lead screening of children at risk for lead exposure. These assessments can include toys, pottery, cosmetics, folk remedies, food, and candy. In some subpopulations, imported products, foods and folk remedies may be more commonly found and are a more substantial contributor to lead exposure.
- Screening types:
- Initial screen: point of care testing; capillary.
- Confirmatory testing: venous sample.
- CDC recommends screening all immigrant, refugee and internationally adopted children when they arrive in the U.S. due to their increased risk.
- Help parents identify if their child has been exposed or has continuous exposure (paint chips, regular visits to houses built before the 1950s, lead in soil, water, pottery and candies from other countries, etc.) and encourage parents to avoid possible lead exposures.
- Monitor all children with a confirmed BLL ≥5 µg/dL for subsequent increase or decrease in BLL until all recommended environmental investigations and mitigation strategies are complete.
- Primary prevention is the most important and significant strategy for reducing BLLs.
- Provide nutritional guidance and recommend a well-balanced diet. Calcium, iron and vitamin C play a specific role in minimizing lead absorption.
- Accumulation of lead can begin during pregnancy. Conduct initial and follow-up screening of pregnant and lactating persons.
- When interacting with affected families, offer simple information about the meaning of BLL results, and relevant and culturally sensitive messages about the impact of lead levels.