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Provider information for lead testing and treatment

Yesterday, the City of Jackson issued a press release regarding elevated levels of lead in some home water samples serviced by the city water system. (City of Jackson Meeting Additional Compliance Measures Related to Lead Exceedance)

To better assist our providers who serve our beneficiaries, the Mississippi Division of Medicaid (DOM) has listed specific instructions about billing and reimbursement related to lead testing and treatment. DOM covers CPT code 83655 (lead testing) outside of the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) or wellness benefit for all beneficiaries when billed with a QW modifier. The ICD-10 code for contact with and (suspected) exposure to lead is Z77.011.

Claims for beneficiaries impacted by the recent Mississippi Department of Health announcement related to City of Jackson Public Water System should include ICD-10 code Z77.011, CPT code 83655 (with QW modifier) and an appropriate Evaluation and Management code, when lead testing is performed outside of the EPSDT or wellness benefit. All applicable Administrative Code, State Plan and provider policies apply.

Please direct any questions related to Division of Medicaid’s lead testing coverage to the Office of Medical Services at 601-359-6150.