Product Lines:
Priority Partners.

Eligible Population:
Members 12-23 months as of December 31 of the measurement year. This includes Population Health Incentive Program (PHIP) and HealthChoice Performance Measure reporting for Priority Partners.

Definition:
This is a Maryland Department of Health (MDH) Lead Measure for Children age12-23 months as of December 31 of the measurement year (i.e., children who turned one year of age during the measurement year) who meet the following criteria:

• Continuously enrolled 90 or more days in a single HealthChoice MCO during the measurement year.
• The child did not dis-enroll from a HealthChoice MCO before their first birthday.
• The child is assigned to the last HealthChoice MCO in which the child was enrolled for at least 90 days in the measurement year.

Best Practice and Measure Tips

• Assessment alone does not meet criteria for this measure – be sure to order the blood test and be sure it is completed.
• Educate parents on the importance of screening for lead poisoning – while the child may not be exposed at home, other environments may present a new risk.

• Visit the MD Department of Health and the Centers for Disease Control and Prevention (CDC) website for additional information for providers and parents / caregivers:

  • Lead Poisoning Prevention (maryland.gov)

  • Physician follow-up Lead Letter (maryland.gov)

  • Lead Poisoning Prevention Program (mde.maryland.gov)

  • Childhood Blood Lead Testing in Maryland: Evaluation and Recommendations (maryland.gov)

  • MDH Blood Lead Testing Certificate (maryland.gov)

  • Best Practices For Lead Poisoning Prevention And Treatment (maryland.gov)

  • Childhood Lead Poisoning Guidelines and Recommendations (cdc.gov)
    
    

Documentation via claims

• This is a Maryland Department of Health (MDH) custom measure and reporting is captured by billing and encounter codes only.

Measure Exclusions

Required Exclusion:

• Members in hospice or using hospice services anytime during the measurement year. 
• Members who died any time during the measurement year.

Measure Codes

Lead Test

• CPT Codes: 83655 and 83645 (CPT Code 83645 was discontinued but is included in the lead Population Health Incentive Program (PHIP).