Aetna considers blood lead testing (measurement of blood lead level) medically necessary for diagnosis of persons with signs and symptoms of lead poisoning (e.g., lowered IQ scores, decreased attention span, impaired hearing, speech and other developmental delays, abdominal pain, headaches, vomiting, and constipation).
Aetna considers lead screening medically necessary for persons with occupational lead exposures.* The United States Occupational Safety and Health Administration (OSHA) mandates lead testing for individuals who have workplace lead exposures.
* Note: Some plans exclude coverage of medical services required for work. Please check benefit plan descriptions for details.
In addition, Aetna considers lead screening a medically necessary preventive health care service for children according to guidelines from the Centers for Disease Control and Prevention (CDC), the U.S. Preventive Services Task Force (USPSTF), the American Academy of Pediatrics (AAP), and the American Academy of Neurology (AAN). Note: Some Aetna plans exclude coverage of preventive services. Please check benefit plan descriptions.
The CDC, the USPSTF, the AAP, and the AAN recommend lead screening of preschool-age children in the following high-risk groups:
Note: No major organizations currently recommend routine screening of asymptomatic pregnant women for elevated lead levels.
Aetna considers measurement of lead in bone, hair, teeth, or urine experimental and investigational because the effectiveness of these approaches has not been established.Background
Lead poisoning is a potentially devastating condition that threatens about 5 % of American pre-schoolers. When lead-based paint peels and chips off of older walls, it can be inhaled and cause permanent damage to a young child's nervous system. Recurrent exposure to even small amounts of lead may result in lead poisoning since lead can accumulate in the body. Neurobehavioral abnormalities of mild lead poisoning may manifest as lowered IQ scores, decreased attention span, impaired hearing, speech and other developmental delays; however, most children of pre-school age with mild lead poisoning are asymptomatic. The probability of developing encephalopathy, the most serious complication of lead poisoning, increases as the exposure to lead and blood level of lead rises. Encephalopathy may be preceded by abdominal pain, headaches, vomiting, and constipation. The Centers for Disease Control and Prevention defines lead poisoning as a blood lead level of 10 mg/dL. As sustained blood levels rise above 10 to 15 mg/dL, young children under age 6 years are at progressively increasing risk not only for future neurobehavioral and cognitive problems, but also for development of recurrent symptomatic episodes of physical manifestations of lead poisoning.
Screening for elevated lead levels in asymptomatic children at increased risk for lead exposure has been demonstrated to improve clinical outcomes. If capillary blood is used as a screening test, elevated lead levels should be confirmed by measurement of venous blood lead.
The optimal frequency of screening for lead exposure in children, or for repeated testing of children previously found to have elevated blood lead levels, is unknown and is left to clinical discretion.
Kosnett et al (2007) summarized a body of published literature that establishes the potential for hypertension, effects on renal function, cognitive dysfunction, and adverse female reproductive outcome in adults with whole-blood lead concentrations less than 40 microg/dL. Based on this literature, and these researchers' collective experience in evaluating lead-exposed adults, they recommended that individuals be removed from occupational lead exposure if a single blood lead concentration exceeds 30 microg/dL or if 2 successive blood lead concentrations measured over a 4-week interval are greatet than or equal to 20 microg/dL. Removal of individuals from lead exposure should be considered to avoid long-term risk to health if exposure control measures over an extended period do not decrease blood lead concentrations to less than 10 microg/dL or if selected medical conditions exist that would increase the risk of continued exposure. Recommended medical surveillance for all lead-exposed workers should include quarterly blood lead measurements for individuals with blood lead concentrations between 10 and 19 microg/dL, and sem-iannual blood lead measurements when sustained blood lead concentrations are les than 10 microg/dL. It is advisable for pregnant women to avoid occupational or avocational lead exposure that would result in blood lead concentrations greater than 5 microg/dL. Chelation may have an adjunctive role in the medical management of highly exposed adults with symptomatic lead intoxication but is not recommended for asymptomatic individuals with low blood lead concentrations.
The United States Occupational Safety and Health Administration (OSHA) mandates lead testing for individuals who have workplace lead exposures. According to OSHA (1995), the blood lead level of all employees who are exposed to inorganic lead above 30 ug/m(3) for more than 30 days per year is to be determined at least every 6 months. The frequency is increased to every 2 months for employees whose last blood lead level was between 40 ug/100 g whole blood. For employees who are removed from exposure to lead due to an elevated blood lead, a new blood lead level must be measured monthly.
There is insufficient evidence to recommend for or against routine screening for lead exposure in asymptomatic pregnant women.
An UpToDate review on “Adult lead poisoning” (Goldman and Hu, 2015) states that “Laboratory testing -- The key clinical monitoring test for diagnosing lead toxicity is the blood lead level [BLL]. Measuring lead in urine, hair, or other media is not as accurate or reliable. The blood lead level is a good indicator of exposure that has occurred within the previous few weeks. In interpreting the results, it is important to use levels appropriate to adult toxicity, rather than children's (which sometimes are the ranges of concern reported by the testing laboratories)”.
An UpToDate review on “Childhood lead poisoning: Clinical manifestations and diagnosis” (Hurwitz and Lee, 2015) states that “Bone and dentine lead levels, measured by K x-ray fluorescence spectroscopy or atomic absorption spectroscopy, respectively, are better indicators of the child's total lead burden than BLLs. However, these tests are not routinely available, and are not recommended by the Centers for Disease Control and Prevention (CDC). BLLs remain the gold standard for the diagnosis of lead poisoning in children”.
|CPT Codes / HCPCS Codes / ICD-10 Codes|
|Information in the [brackets] below has been added for clarification purposes.  Codes requiring a 7th character are represented by "+":|
|ICD-10 codes will become effective as of October 1, 2015:|
|CPT Codes covered if selection criteria are met:|
|83655||Lead [not covered for measurement of lead in bone, hair, teeth, or urine]|
|ICD-10 codes covered if selection criteria are met (not all-inclusive):|
|D50.0 - D50.9||Iron deficiency anemia|
|F50.8||Other eating disorders [Pica in adults]|
|F80.0 - F89||Pervasive and specific developmental disorders|
|F98.3||Pica of infancy and childhood|
|G40.001 - G40.919||Epilepsy and recurrent seizures|
|G44.1||Vascular headache, not elsewhere classified|
|H90.0 - H91.93||Conductive and sensorineural hearing loss|
|K59.00 - K59.09||Constipation|
|R10.0 - R10.13
R10.30 - R10.829
R10.84 - R10.9
|R11.0 - R11.2||Nausea and vomiting|
|R40.20 - R40.3||Coma|
|R40.4||Transient alteration of awareness|
|R53.0 - R53.1
|Other malaise and fatigue [lethargy]|
|R62.0 - R62.59||Lack of expected normal physiological development in childhood|
|T56.0X1+ - T56.0X4+||Toxic effect of lead and its compounds|
|T74.02X+||Child neglect or abandonment, confirmed|
|T74.92X+||Unspecified child maltreatment, confirmed|
|Z77.011||Contact with and (suspected) exposure to lead|