Product Lines:
Priority Partners.

Eligible Population:
Members 12-23 months as of December 31 of the measurement year. This includes Value Based Purchasing (VBP) 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:

  • https://health.maryland.gov/phpa/OEhfp/eh/Pages/Lead.aspx

  • https://health.maryland.gov/phpa/OEHFP/EH/Shared%20Documents/Lead/HB1233_ClinicianLetter_03022021.pdf

  • https://www.cdc.gov/nceh/lead/default.htm

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 value-based purchasing program).