MedicaidBilling CodesMedium impact
Childhood Lead Screening
Illinois Medicaid - HFS·IL · Pediatrics, Family Medicine, General Practice·Provider Notice
Effective date
Dec 19, 2008
We identified it
Jun 21, 2026
Summary
Illinois Healthcare and Family Services reminds providers that all HFS-enrolled children must receive blood lead screening at 12 and 24 months (or up to 72 months if not previously screened). Providers can now bill CPT 83655 with QW modifier for CLIA-waived blood lead analysis, or CPT 36415/36416 with U1 modifier for blood draws sent to IDPH laboratory. All preventive child health services including lead screening must use preventive diagnosis codes with the 'V' prefix or claims will be rejected.
Action Required
Immediately: Update billing system to ensure CPT 83655 includes QW modifier for CLIA-waived blood lead testing and CPT 36415/36416 include U1 modifier for blood draws sent to IDPH. Verify all preventive child health services including lead screening use diagnosis codes with 'V' prefix (e.g., V202). Train billing staff that claims without the 'V' will be automatically rejected. Update encounter forms to remind providers of required screening ages (12, 24, and up to 72 months for unscreened children).