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20-955 Is Your Screening of Young Children's Blood Lead Levels Compliant?

Date: 12/01/20

Provide blood lead screening tests in accordance with the California Code of Regulations

When you perform periodic health assessments (PHAs) on children between the ages of 6 months to 6 years, you must comply with state and federal laws to provide anticipatory guidance and screen children for elevated blood lead levels.

Summary of blood lead screening requirements are outlined as follows. See Additional Information section for more information on state and federal laws.

Stay compliant by following these blood lead screening guidance

Per Centers for Disease Control and Prevention (CDC), even low levels of lead exposure in young children could lead to learning, developmental and behavioral problems, including low IQ, damage to the brain and nervous system, and speech and hearing impairment.1 Steps taken to prevent lead exposure can mitigate health risks to children.

On November 2, 2020, the Department of Health Care Services (DHCS) released All Plan Letter (APL) 20-016 with the following additional provider documentation requirements for blood lead screenings in young children.

  • In the scenario that a child’s parent or care giver withholds consent for a lead test, you are required to document this in the child’s medical record by obtaining a signed statement of voluntary refusal, or
  • Document the reason the signed statement of voluntary refusal was not obtained, such as parent refused or declined to sign it, care was conducted via telehealth, etc.

California Health & Wellness Plan (CHWP) outlined the childhood blood lead screening requirements in provider update 19-054, Childhood Blood Lead Screening, distributed February 8, 2019. As a reminder, you must:

  • Provide blood lead screening tests in accordance with the California Code of Regulations (CCR). See Additional Information section for more information.
  • Include as part of the oral or written guidance to parents or guardians that2:
    • Children can be harmed by exposure to lead, especially deteriorating or disturbed lead-based paint and the dust from it,
    • Children are particularly at risk of lead poisoning from the time the child begins to crawl until 72 months of age.
  • Order or perform blood lead screening tests on all child members in accordance with the following:
    • At 12 months and at 24 months of age.
    • When you become aware that a child member has no documented evidence of a blood lead screening at:
      • 12 months of age or thereafter, and
      • Ages 24 to 72 months.
    • At any time a change in circumstances, in your professional judgement, put the child member at risk.
    • If requested by the parent or guardian.
  • Follow the CDC Recommendations for Post-Arrival Lead Screening of Refugees contained in the guidelines issued by the California Department of Public Health’s Childhood Lead Poisoning Prevention Branch (CLPBB).
  • Document the reason(s) for not performing a blood lead screening test in the child’s medical record.
  • Follow the CLPBB guidelines and deliver all medically necessary care as required under Early and Periodic Screening, Diagnostic, and Treatment (EPSDT). Guidelines are provided in APL 20-016.
  • Report lead test results to the CLPBB

Use the following codes when billing

Codes submitted will help determine if a child has received the lead screening.



Lead test

CPT® 83655

Encounter for screening for disorder due to exposure to contaminants

ICD-10 Z13.88

Additional Information

For detailed information regarding this regulation, refer to APL 20-016 on DHCS site.

For more information on blood lead screening tests in accordance with CCR, refer to Title 17, Division 1, Chapter 9, Articles 1 and 2, section 37100 of the CCR.

For all other questions, contact CHWP at 1-877-658-0305.


1 CDC’s Childhood Lead Poisoning Prevention information can be found at:

2 Guidance must be provided to the parent or guardian at each periodic health assessment, starting at 6 months of age and continuing until 72 months of age.