4 Accessing Medicaid reimbursement

POLs participating with a managed care plan must bill the Medicaid Managed Care or Family Health Plus (FHPlus) plan for in-office lead testing for dates of service on or after September 1, 2009, using CPT-4 procedure code 83655. Reimbursement will be in accordance with agreements between the provider and the health plan.

Lead testing can be provided in a POL, provided that it is performed by physicians, nurse practitioners, licensed midwives, or trained employees. In order for a practitioner to access Medicaid reimbursement, s/he must be enrolled with Medicaid as a physician office laboratory (POL) and must comply with requirements for reporting of blood lead test results to the NYSDOH (see reporting requirements in Step 3 above.)

The provider's records must document the following to be entitled to reimbursement:

• Operation of any CLIA-waived test device is in accordance with both the manufacturer's instructions (the package insert) and standards of laboratory practice as posted at www.nyhealth.gov/environmental/lead
• Proper procedures for collection of fingerstick blood samples are followed to avoid contamination and otherwise ensure reliable results
• Timely referral is made for confirmation of all blood lead specimens/patients with test results greater than or equal to 8 μg/dL using a venous sample analyzed by a clinical laboratory that holds a NYS permit in toxicology-blood lead.