Quantitative blood lead measurement, ordered in orthopedics mainly when retained bullet fragments or intra-articular metal raise concern for lead toxicity.
- Medicare
- $0.00
- Work RVU
- 0
- Global, days
- Region
- General
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 3 cited references ↓
- History of retained bullet or metal fragment, with location
- Symptoms or findings suggesting lead toxicity, if present
- Imaging showing the fragment and its relation to the joint
- Plan for fragment removal or monitoring
- Lab report with sample type and lead level
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 3 cited references ↓
A blood lead level is 83655. In orthopedics the classic reason is a retained bullet, especially one sitting in or next to a joint. Synovial fluid dissolves lead over time, and patients can develop systemic lead toxicity years after the injury. Trauma surgeons order a blood lead level when deciding whether to remove fragments, and again after removal.
The diagnosis needs to tell the story: retained foreign body, the old gunshot wound, and any symptoms like abdominal pain, fatigue, anemia, or neuropathy. A lead level ordered with only an arthritis code will look like a screening test and get denied.
Some point-of-care lead analyzers are CLIA-waived, mostly used in pediatric offices. If your office runs a waived test, append QW for Medicare. Venous and capillary samples are both reported with 83655, but an elevated capillary result is usually confirmed with a venous draw, and that confirmation is billed as its own test.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 0 |
| Practice expense RVU | 0 |
| Malpractice RVU | 0 |
| Total RVU | 0 |
| Medicare national rate | $0.00 |
| Global period | days |
Payment by site of service
Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.
Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026
| Setting | Medicare rate (national) |
|---|---|
Office (PFS non-facility) Procedure performed in physician's office | $0.00 |
Common denial reasons
The recurring reasons claims for CPT 83655 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- No diagnosis explaining lead exposure
- Screening indication billed without screening coverage
- Missing QW on a waived point-of-care test
- Frequency beyond payer limits without new findings
- Billed by both office and reference lab
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 3 cited references ↓
01Why would an orthopedic surgeon order a lead level?
02What diagnosis codes support 83655 for a retained bullet?
03Does 83655 need modifier QW?
Sources & references
Editorial content was developed using the following public sources.
Mira Scribe
Mira Scribe records the retained fragment, its location, and the patient's symptoms, which is the history a payer needs to see behind a lead level.
See how Mira captures CPT 83655 documentation