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.
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What to do
Action · 8 steps
01Before October 1, 2025: If your organization performs environmental lead investigations, complete the following enrollment steps.
02Billing 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.
03Create a Business Profile on Maryland's ePREP system.
04Submit 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.
05Update 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).
06Verify 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.
07Failure to complete enrollment will prevent claims processing.
08Update clinical staff on new lower BLL threshold (3.5μg/dL vs. previous 5μg/dL) for referral eligibility.
Codes mentioned
T1029
Original notice
Lead Paint Risk Assessor Billing
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