All PlansCoverageMedium impact
Updated blood lead reference value for children
UPMC Health Plan·Pediatrics, Family Medicine·Provider Announcement
Effective date
Oct 28, 2021
We identified it
Aug 7, 2026
Summary
The CDC has lowered the blood lead reference value (BLRV) for children from 5 µg/dL to 3.5 µg/dL, effective immediately. This means more children will be identified as having elevated lead levels requiring clinical attention, case management referrals, and environmental investigation. Billing teams should ensure providers are aware of the updated screening threshold and that referrals to UPMC Pediatric Care Management are processed correctly for appropriate case management billing.
Action Required
Immediately: Notify all pediatric providers and family medicine practitioners of the new 3.5 µg/dL blood lead reference value. Ensure billing team recognizes that case management referrals (email: pedscasemanagement@upmc.edu or call 1-866-778-6073) should be processed for children meeting the new threshold. Update screening protocols and ensure clinical staff document blood lead levels accurately in the EMR to reflect the revised BLRV. No billing code changes required, but ensure claims for pediatric case management services related to elevated lead levels are submitted with appropriate documentation linking to the updated CDC guidance.