Back to Insights and Updates for ProvidersMarch 2024

Billing for lead screening

Harvard Pilgrim Health Care Commercial  |  Tufts Health Direct  |  Tufts Health Plan Massachusetts Commercial products

Lead screenings are considered a preventive service for ages 0-6 years and are required under the Affordable Care Act to be covered with no member cost share when rendered by an in-network provider.

For preventive lead screenings you must bill the appropriate CPT procedure code (83655) with the correct ICD-10 diagnosis code (Z13.88).

When submitting claims for these services, it’s important to bill in accordance with our Harvard Pilgrim Patient Protection and Affordable Care Act (Federal Health Care Reform) policy and Tufts Health Plan Preventive Services Payment Policy to ensure that member cost sharing is not applied inappropriately.

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