Skip to main content
COVID-19

Lead Screening in Children (LSC)

Based on current NCQA HEDIS and the State of New Jersey recommendations, your TO-DO List for pediatric patients should include:

  • Medicaid Members – Order a capillary or venous lead blood test by the child’s 1st birthday and again by the child’s 2nd birthday

Why should you complete your TO-DO LIST?

It is an evidence-based, best practice and these actions are used to measure your quality performance.

Population Defined for Lead Screening in Children

(NCQA HEDIS guidelines, Measurement Year (MY) 2022)

  • Members who turn 2 years of age during the measurement year
  • Line of Business: Medicaid

The following is based on the State of New Jersey’s recommendations:

DESCRIPTION: REQUIREMENT:
Required testing by the State of New Jersey at 12 and 24 months of age.

Providers will have a compliance rate of greater than 80% for two consecutive six months periods for lead level tests

Perform capillary or venous blood test:
  • Between nine (9) months and eighteen (18) months of age – target age twelve (12) months

AND

  • Between eighteen (18) months and twenty- six (26) months of age – target age twenty- four (24) months

The following is based on NCQA’s HEDIS recommendations:

DESCRIPTION: REQUIREMENT:
The percentage of children 2 years of age who had one or more capillary or venous lead blood tests for lead poisoning by their second birthday Perform one or more capillary or venous lead blood tests on or before member’s second birthday.

How does your completion of the TO-DO LIST get recorded?

  • Refer to Coding Tables.

Resources available for you and your patients:

  • New Blood Lead Level Information, Centers for Disease Control and Prevention: cdc.gov/nceh/lead

References:

  1. Lead Screening in Children, NCQA HEDIS Measurement Year (MY) Tech Specifications 2022

Coding Tables

Lead Screening in Children (LSC) HEDIS Measure Billing Code:

CPT 83655                  
LOINC 10368-9 10912-4 14807-2 17052-2 25459-9 27129-6 32325-3 5671-3 5674-7 77307-7
SNOMED CT US Edition 8655006 35833009                

Supplemental Data Requirements

LSC

- Lab report, progress note, or NJIIS form indicating lead test, date, and results.

General Notes

The most accurate method to submit data for clinical quality gap closure is through correct coding. Supplemental data submission can be used for gap closure when information is not received through coding. All supplemental data must be signed and dated by a treating physician, nurse practitioner or physician assistant. All dates must include month, day and year.

Patient name and birthdate needs to be on all supplemental documentation. If birthdate is not officially on a report, it needs to be either written on the document and signed by the physician, or a demographic cover sheet should be included as an additional page with the submission.

To learn more about your practice’s current HEDIS performance for this or other measures, or for assistance in compliance with the HEDIS guidelines, please contact Horizon Healthy Journey at 1-844-754-2451.

Reference: NCQA HEDIS Measurement Year (MY) 2022 Technical Specs CPT® is a registered trademark of the American Medical Association.

Products are provided by Horizon Insurance Company and/or Horizon NJ Health. Communications are issued by Horizon Blue Cross Blue Shield of New Jersey in its capacity as administrator of programs and provider relations for all its companies. All are independent licensees of the Blue Cross Blue Shield Association. The Blue Cross® and Blue Shield® names and symbols are registered marks of the Blue Cross Blue Shield Association. The Horizon® name and symbols are registered marks of Horizon Blue Cross Blue Shield of New Jersey. © 2022 Horizon Blue Cross Blue Shield of New Jersey. Three Penn Plaza East, Newark, New Jersey 07105.