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	CLIA Waiver & CA Registration	Reporting	Proficiency Testing	Reimbursement

Accessing Reimbursement for CHDP Fee-for-Service Providers

To access reimbursement through the California Department of health Care Services (DHCS) Child Health and Disability Prevention (CHDP) program you must participate in a proficiency-testing program and be included on the list of proficient laboratories maintained by the California Blood Lead proficiency Assurance Program (CBLPAP).

• The California Department of Public Health's Environmental Health Laboratory Branch will notify CMS that your office is deemed proficient for blood-lead analysis and send you a letter of confirmation

• You can submit claims AFTER you have received the formal letter and notification from Electronic Data Systems

  • CHDP Program Letter No.: 09-02 and example letter.

• You will be approved to bill as a laboratory provider for blood-lead using code 15 ($22.45)

  • This code must be billed on a separate PM 160 Claim Form using your National Provider Identifier (NPI) number.
  • You must also indicate a place of service code of 81 (lab) in the two-digit place of service field on the PM 160
• It is necessary to complete a PM 160 for all other services - for example, if billing for code 23 (lead counseling and blood drawing for lead testing at the rate of $18.73), you would complete a separate PM 160 using your NPI number and indicating a place of service code 11 (office) in the two-digit place of service field on the PM 160.
  Example PM 160 forms for Code 15 and Code 23:
  • Code 15
  • Code 23

 

Use CPT code 83655 to access reimbursement from private insurers

• Verify your office has a CLIA Certificate of Waiver
• Register with CA Laboratory Field Service
• Report all blood-lead results electronically to the state

To purchase a LeadCare II system, call (800) 305.0197