Reminder: Blood Lead Testing Requirements and MaineCare Reimbursement

Apr 02, 2025

This message provides clarity about MaineCare requirements, coverage, reimbursement, and incentives of blood lead testing for children.

Maine law requires testing of all children aged one and two-years (22 M.R.S. §1317-D). Blood lead testing is also a performance measure within the following MaineCare models, which means there is a financial incentive to provide these critical tests:

• Primary Care Plus is a model that supports primary care practices who provide whole person care to members through a monthly payment reflecting their patient population and the quality and type of care they provide.
• Accountable Communities (AC) is a shared-savings model for groups of providers who volunteer to participate. This payment model creates incentives for ACs to make investments that improve cost and quality outcomes.

The drawing of blood for the testing may be done in the healthcare provider’s office or may be referred to a laboratory.

We updated the reimbursement rates in the table below with an April 2, 2025, effective date.

Blood Lead Testing Codes
CPT	CPT Code Description	Diagnosis (DX) Code	DX Code Description	Rate
36415	Collection venous blood venipuncture – lead specimen collection	Z13.88	Encounter for screening for disorder due to exposure to contaminants	$5.70
36415		Z77.011	Contact with and (suspected) exposure to lead	$5.70
36415		Any Other Qualifying DX Code		$2.17
36416	Collection capillary blood specimen – lead specimen collection	Z13.88	Encounter for screening for disorder due to exposure to contaminants	$5.70
36416		Z77.011	Contact with and (suspected) exposure to lead	$5.70
36416		Any Other Qualifying DX Code		$2.17
83655	Lead testing and specimen collection			$12.11

 

* Please note that MaineCare providers who are in private practice are reimbursed at an enhanced reimbursement rate for venous and capillary blood draws, only when the listed Diagnosis Code (DX) is included on the claim. To review the most recent fee schedules, please visit: Health Pas Online Portal.

How can Maine Centers for Disease Control and Prevention (CDC) support providers?

The Maine CDC offers assistance in:

• Adjusting workflows to improve testing rates

• Interpreting test results
• Offering education for clinical staff
• Facilitating STAT testing at the State lab
• Speaking directly with families of children with lead in their blood

For more information, please review the Maine CDC Lead Screening and Follow-up Guidelines which include information on who to test; how to interpret results; advice on ways for families to take immediate action; and which supports are provided by the Maine CDC. You may also contact Dr. Maggie Bordeau, from the Maine CDC Childhood Lead Poisoning Prevention Program.