May 22, 2026
Lead exposure continues to present significant health risks for children under age 6. You can help close gaps in care through well-child visits, patient education and careful documentation and coding.
Required screening: For all children enrolled in Medicaid, blood lead screening is federally required at 12 and 24 months of age. Catch-up testing is required for children between 24 and 72 months old with no previous record of screening.
To close care gaps, blood lead screening should be conducted before children’s second birthday for the quality measure Lead Screening in Children. Learn more.
Well-child visits are a key component of the Medicaid Early and Periodic Screening, Diagnostic and Treatment program to ensure preventive care requirements are met, including routine blood lead testing. Identifying elevated levels early may allow you to initiate interventions, coordinate care and educate caregivers on how to reduce or eliminate their child’s exposure.
Patient education: Consider sharing information with caregivers about the importance of testing. Even low levels of lead can cause serious and lasting harm, including:
- Cognitive impairment and developmental delays
- Behavioral challenges and decreased attention span
- Long‑term impacts on academic performance and overall health
Documentation and coding: Accurate and complete documentation and coding help ensure proper reporting and compliance with related quality measures. Clearly document blood lead screening information in the patient’s medical record and use appropriate Current Procedural Terminology (CPT®) or ICD-10-CM codes on claims.
For more information refer to the Texas Health and Human Services and Texas Department of State Health Services for resources.
Learn more about quality measures: Refer to Quality Care 2026, our resource on documentation and coding for Healthcare Effectiveness Data and Information Set (HEDIS®) measures. Sign in to Availity® Essentials and visit our Payer Spaces.
Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to Blue Cross and Blue Shield of Texas. BCBSTX makes no endorsement, representations or warranties regarding third party vendors and the products and services they offer.
CPT copyright 2025 American Medical Association. All rights reserved. CPT is a registered trademark of the AMA.
The material presented here is for informational and educational purposes only, is not intended to be medical advice or a definitive source for coding claims and is not a substitute for the independent medical judgment of a physician or other health care provider. Health care providers are encouraged to exercise their own independent medical judgment based upon their evaluation of their patients’ conditions and all available information, and to submit claims using the most appropriate codes based upon the medical record documentation and coding guidelines and reference materials. References to other third party sources or organizations are not a representation, warranty or endorsement of such organization. The fact that a service or treatment is described in this material, is not a guarantee that the service or treatment is a covered benefit, and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions.
HEDIS is a registered trademark of the National Committee for Quality Assurance.