Clinicians, patients and payers can each realize benefits from an in-office blood lead testing program, including:
Providing 100% compliance – you know the test gets done
Enabling immediate diagnosis, education and follow up
Increasing patient and parent satisfaction – one visit, one fingerstick
As a result, in-office lead testing is covered by most plans as a clinically important, cost effective alternative to having testing performed by an off-site laboratory.
The links below are intended to offer providers and staff information and sample letters to assist with the coverage, coding and payment of in-office blood lead testing.
If you have questions or need assistance, please email us at firstname.lastname@example.org.
View/download our Coding & Reimbursement Guide.
To determine how a plan covers in-office testing, you can contact the plan provider line or send a letter requesting authorization.
Sample Letter of Medical Necessity
When an insurance company does not pay for blood lead testing because it is performed in the physician office rather than at a laboratory, providers can request a policy change using these sample letters:
Physician Office Testing: Request for Policy Change to allow for in-office lead testing.
Physician Office Testing: Sample Appeal Letter for denial of coverage based on laboratory requirement.
For other appeals, providers may wish to consult these sample letters:
Sample Appeal Letter for Denial of Coverage
Sample Appeal Letter for Low Payment Rate
Providers may wish to include the following supporting documentation:
LeadCare II Product Specifications
LeadCare II Product Benefits
LeadCare II Package Insert