Universal Blood Lead Toxicity Testing

Universal Blood Lead Toxicity Testing: A Crucial Component of Highmark Wholecare’s EPSDT Benefit

Highmark Wholecare’s Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit requires universal blood lead toxicity testing for children by 12 months of age and at 24 months of age. As a part of this EPSDT benefit, providers are also required to test children between the ages of 30 and 72 months of age if they have not been previously tested for lead poisoning.

A capillary sample may be used for the blood lead test. If this comes back as an Elevated Blood Lead Level (EBLL), then a venous sample should be used for confirmation (please refer to the Centers for Disease Control (CDC) guidelines if a child is unable to sit for a venous draw for medical reasons). Blood lead is considered elevated at 3.5 micrograms per deciliter. While there is no safe lead level in children, the CDC uses a Blood Lead Reference Value to determine when follow up actions should be taken. For information on CDC guidance, see their recommended actions based on blood lead level.

To align with the CDC’s guidelines, providers should manage the condition of a child who has an EBLL that is greater than or equal to 3.5µg/dL. This should include follow-up blood tests and consideration of possible sources of contamination including housing, food, and toys. Locating the source of lead contamination is an integral part of the management and treatment of lead toxicity.

Once a child has a confirmed EBLL they should, without delay, receive the following:

1. Referral for Environmental Lead Investigation from a Highmark Wholecare Environmental Lead Investigation (ELI) Provider– services are limited to 1 ELI per household/address.
2. Between ages 0 -6: Referral to Early Intervention or DART for tracking services. This can be done through the CONNECT Helpline at 1-800-692-7288.
3. Additional developmental screenings by the provider to ensure that the member is achieving developmental milestones on time.

If you have questions regarding Highmark Wholecare’s EPSDT program, please visit the Highmark Wholecare EPSDT PRC page or email EPSDTinfo@HighmarkWholecare.com.