MedicaidCoverageMedium impact
Lead Paint Risk Assessor Billing
Maryland Medicaid·MD · Pediatrics·EPSDT
Effective date
Oct 1, 2025
We identified it
Jun 20, 2026
Summary
Maryland Medicaid now covers environmental lead investigations for children under 21 with elevated blood lead levels at or above 3.5μg/dL (lowered from 5μg/dL), effective October 1, 2025. Lead Paint Risk Assessor organizations must enroll as Medicaid providers and bill using code T1029 at $418.49 per dwelling per year. This policy supersedes PT 16-20 from 2019.
Action Required
Before October 1, 2025: If your organization performs environmental lead investigations, complete the following enrollment steps: (1) Billing team and compliance staff must obtain Type 1 NPIs (Taxonomy 247200000X) for each MDE-accredited inspector and one Type 2 NPI (Taxonomy 251K00000X) for the organization through NPPES; (2) Create a Business Profile on Maryland's ePREP system; (3) Submit Group and Individual provider enrollment applications on ePREP, ensuring each individual inspector's MDE certification is uploaded and linked to the organization's Type 2 NPI; (4) Update billing software to recognize T1029 code with $418.49 reimbursement rate, Place of Service 12 (home), and billing limitations (one claim per property per year); (5) Verify Medicaid coverage for all eligible participants (children under 21 with confirmed BLL ≥3.5μg/dL within last 6 months) before service delivery using Maryland Medicaid Electronic Verification System. Failure to complete enrollment will prevent claims processing. Update clinical staff on new lower BLL threshold (3.5μg/dL vs. previous 5μg/dL) for referral eligibility.