Lead-Safe Wisconsin: Medicaid Reimbursement for Lead-Related Services

Local Health Departments can bill Medicaid for lead-related services in certain circumstances. Find contact information, resources, and answers to frequently asked questions below.

Contact information

For questions about billing Medicaid, contact:

For questions about childhood lead poisoning, contact the Wisconsin Childhood Lead Poisoning Prevention Program (CLPPP) at DHSLeadPoisoningPrevention@dhs.wisconsin.gov or 608-266-5817.

Resources

  • Childhood Lead Poisoning Prevention Program webinar on Medicaid reimbursement for lead-related services

Requirements for Medicaid billing

The local health department and patient must meet certain criteria in order for Medicaid to reimburse the local health department for lead-related services.

The local health department must:

  • Be enrolled as a HealthCheck provider.
  • Submit the claim within 365 days of the service provided.
  • Submit appropriate documentation of services.

The patient must:

  • Be between 0 and 20 years old.
  • Qualify for Medicaid services.
  • Have a blood lead result of at least 3.5 micrograms per deciliter (mcg/dL) for lead poisoning follow-up services.

Requirements FAQ (frequently asked questions)

Medicaid billing and reimbursement

Qualifying local health departments can bill for lead-related services electronically or by fax/mail using the following codes and modifiers*:

Blood lead testing codes

  • 99211: Office/outpatient visit (established patient)
  • 99000: Specimen handling office-lab (only to be used when a fingerstick blood specimen is mailed to a laboratory for analysis)
  • 36416: Capillary blood draw
  • 83655: Blood lead analysis (assay of lead) (only be used when doing on-site blood lead testing using a point-of-care device)

Lead poisoning follow-up activity codes

Medicaid refers to lead poisoning follow-up activities as "Environmental Lead Investigation" (ELI) services. The following procedure codes can be used for ELI services:

  • T1002: In-person or telehealth nursing visit (must be completed by registered nurse)
  • T1029: Environmental investigation
    • Use modifier TS in the second modifier position if the service represents a lead clearance investigation.

ELI claims should also include:

  • a POS (place of service code) of 12 (home), 10 (telehealth in the home), or 02 (telehealth outside the home).
  • a diagnosis code of Z77.011 (contact with and [suspected] exposure to lead).
  • HealthCheck service modifier EP submitted in the primary modifier position.

*For the most up-to-date information on procedure codes, visit Forward Health Topic 11239: Blood Lead Screening Test and Topic 2398: Environmental Lead Investigations (ELI).

Billing and reimbursement FAQ

Nurse education visits

Phone and in-person nurse education visits can be billed in 15-minute billable units. Up to four billable units (totaling up to one hour) may be billed per day, per provider, per child. Nurse education visits must be performed by a registered nurse to qualify for reimbursement.

Nurse education FAQ

Property investigations

ForwardHealth covers certain property investigation activities, including:

  • An initial comprehensive environmental lead investigation (one per rolling year, per provider, per residence).
  • Follow-up lead clearance investigations.

In order to qualify for reimbursement, these activities must be performed by either:

  • A local health department enrolled as HealthCheck provider.
  • A Wisconsin Department of Health Services-certified lead hazard investigator (or risk assessor) contracted with the local health department.

Property investigations FAQ

Last revised December 12, 2024