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Modification to Codes that require Filing to TPL

Effective for dates of service on or after July 1, 2017, and as required by 1902(a) (25) of the Social Security Act, the South Carolina Department of Health and Human Services (SCDHHS) will implement cost avoidance rules for the procedure codes reflected below. Service providers will be required to file claims to any liable third-party insurer before submitting a claim to SCDHHS for payment. Claims filed with SCDHHS prior to billing all liable third-party insurers and appropriately documenting the third party filing on the claim submitted to Medicaid will receive all applicable claim edits. Resolution of applicable claim edits for the issues described above are outlined in the appendices of each SCDHHS provider manual, located at https://www.scdhhs.gov/provider-manual-list.

Codes:  

90460925929753099393T1013V5090
90461970019924199394T1016V5264
908859716199381G9007T1017X8185
925079716299382H2019T1023X8186
925089716399383S8180T1024 
925529716599384S8185T1025 
925579716699391S9445T1027 
925909716799392S9446V5011 

This policy applies to audiologists, anesthesiologists, certified registered nurse Anesthetists and comprehensive outpatient rehabilitation facility providers.

Please refer any questions or concerns regarding this bulletin to the Provider Service Center at (888) 289-0709.

Thank you for your continued support of the South Carolina Healthy Connections Medicaid program.

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