Clinicians, patients, and payers can realize the benefits from an in-office blood lead testing program, including:

• Providing 100% compliance – you know the test gets done
• Enabling immediate diagnosis, education and follow up
• Increasing patient and parent satisfaction – one visit, one fingerstick

As a result, in-office lead testing is covered by most plans as a clinically important, cost-effective alternative to having testing performed by an off-site laboratory.

The links below are intended to offer providers and staff information and sample letters to assist with the coverage, coding, and payment of in-office blood lead testing.

If you have questions or need assistance, please email us at reimbursement@magellandx.com.

View/download our Coding & Reimbursement Guide.

To determine how a plan covers in-office testing, you can contact the plan provider line or send a letter requesting authorization.

Sample Letter of Medical Necessity

When an insurance company does not pay for blood lead testing because it is performed in the physician’s office rather than at a laboratory, providers can request a policy change using these sample letters:

Physician Office Testing: Request for Policy Change to allow for in-office lead testing.
Physician Office Testing: Sample Appeal Letter for denial of coverage based on laboratory requirement.

For other appeals, providers may wish to consult these sample letters:

Sample Appeal Letter for Denial of Coverage
Sample Appeal Letter for Low Payment Rate

Providers may wish to include the following supporting documentation:

LeadCare II Product Specifications
LeadCare II Product Benefits