Lead Testing

Protecting children from lead exposure is crucial for lifelong good health. Even low levels of lead in the blood can negatively affect learning, attention, and academic performance. 

Prevention Strategies

• Primary Prevention: Remove lead hazards from the child’s environment. 
• Secondary Prevention: Conduct blood lead risk assessments and testing with appropriate follow-up care and referrals. 

California Blood Lead Testing Requirements

Per California Department of Public Health (CDPH) regulations, children in publicly sponsored programs (e.g., Medi-Cal, CHDP, WIC) must receive blood lead testing at: 

• 12 months and 24 months of age. 

Provider Responsibilities

• Submit claims timely to ensure tests are included in incentive calculations. 
• Document both the test date and results in the medical record. 

Quality Care Incentive Program (QCIP) Measure

The “Lead Screening in Children” measure within QCIP aims to improve testing rates for children by their second birthday. 

Clinical Guidelines and Monitoring

CDPH, Centers for Disease Control and Prevention (CDC), and the American Academy of Pediatrics (AAP) recommend specific practices to identify and mitigate lead exposure risks in children.

CenCal Health conducts ongoing medical record audits to ensure compliance with clinical guidelines, which includes timely follow-up for abnormal findings, is completed and properly documented. Findings are shared and discussed with audited providers. Overall findings are shared networkwide to ensure continuous improvement. 

Core Components of Lead Exposure Management

The three core components—Risk Assessment, Routine Testing, and Anticipatory Guidance—are essential for managing lead exposure. The table below (adapted from AAP Bright Futures Periodicity Schedule) outlines age-specific procedures and screening expectations for lead exposure management, highlighting when risk assessments, screenings, or follow-up actions are recommended. 

Risk Assessment: 

• Conduct routine evaluations during periodic assessments (6 months to 6 years). 
• Identify environmental or behavioral factors that increase a child’s risk of lead exposure. 

Routine Testing: 

• Perform blood lead tests for all children in publicly funded programs at 12 months and 24 months. 
• Order catch-up testing if missed at these ages. 

Anticipatory Guidance (6 months to 6 years): 

• Educate parents about the risks and effects of lead exposure. 

• Inform parents about the Medi-Cal blood lead testing requirement. 

• Provide health education materials on lead exposure screening (Does My Child Need a Lead Test? PDF Handout). 

• Refer parents to our online health library for additional resources on lead testing and prevention. 

Lead Risk Assessment and Testing Timeline for Pediatric Preventive Care

Below are the recommendations for preventive pediatric health care by the American Academy of Pediatrics (AAP) and Bright Futures. This table is a timeline specifically for lead risk assessment and testing. For a more detailed list of recommended preventative pediatric care, please refer to the AAP periodicity PDF. 

Infancy

Early Childhood

Middle Childhood

Additional Responsibilities for Quality Care

In addition to the core components, the following practices are essential:

• Documentation: 

• Record instances where a risk assessment or lead test is not administered or refused. Download the refusal form template. 
• If point-of-care testing is not available at your practice, document the lead test order.

• Abnormal Results: 

• Report abnormal lead test results to your County Department of Public Health and the California Lead Poisoning Prevention Branch. 

Billing for Blood Lead Testing

• Use Lead Testing CPT code: 83655

Best Practices