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Screening and Billing for Anemia

Published Date: July 22, 2026

Incorporate anemia screenings for children and infants, and use the proper code for the appropriate Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) visit.

The American Academy of Pediatrics (AAP) and the American Family Physician (AFP) identify anemia screening as a universal screening. Despite this recognition, iron deficiency and iron-deficiency anemia continue to be of concern and can have adverse effects on neurodevelopment in infants and children.

Highmark Wholecare Providers should conduct anemia screenings at the following ages:

Between 9 and 12 months of age.
Risk assessment for anemia at 4 months of age, 15 months of age, and then each well child visit thereafter, as recommended by the AAP.
For females after 12 years of age, once menses starts.

For more information, please refer to CDC Morbidity and Mortality Weekly Report (MMWR).

Billing

All EPSDT screening services must be reported with age-appropriate evaluation and management code along with the EP modifier:

1 month to 11 months EPSDT visit CPT Code is 99381 or 99391
12 months to 4 years EPSDT visit CPT Code is 99382 or 99392
12 years to 17 year EPSDT visit CPT Code is 99384 or 99394
18 years through 20 years EPSDT visit CPT Code is 99385 or 99395

Provider should choose the most appropriate test:

The CPT code for spun Hematocrit is 85013
The CPT code for Hemoglobin is 85018

Modifier:

90 when applicable
When laboratory procedures are performed by a party other than the treating or reporting physician, use CPT code plus modifier 90 Reference Outside Lab. This modifier is used to indicate that although the physician is reporting the performance of a laboratory test, the actual testing component was a service from laboratory.

For questions regarding the EPSDT program, please contact HWC_EPSDTInfo@Highmark.com.

These codes are not all encompassing and use does not guarantee payment. They are intended as a guide to provide education around appropriate screenings and coding as part of the EPSDT program.