ASD Addition of New Covered Codes, Rate and Service Limit Increases
Effective for dates of service on or after July 1, 2023, the South Carolina Department of Health and Human Services (SCDHHS) will add coverage of the ASD group treatment services described below. Additionally, the agency will increase the reimbursement rate and service limit for the ASD services listed below. The changes announced in this bulletin will be added to the ASD Services provider manual and ASD fee schedule available on SCDHHS’ website. SCDHHS is making these changes, which are in alignment with the work and recommendations of the Palmetto Autism Study Committee, to support access to ASD services, enhance the state’s provider network and ensure services are delivered effectively and are in alignment with the work and recommendations of the Palmetto Autism Study Committee.
Addition of Group Treatment Services
| Code | Description | Rate | Service Limit |
|---|---|---|---|
| 97154 | Group Adaptive Behavior Treatment by Protocol, multiple patients, performed by a Registered Behavioral Technician (RBT) | $9.10/15-minute unit ($36.40/hour)
| 6 hours per day |
| 97158 | Group Adaptive Behavior Treatment by Protocol, multiple patients, performed by a Board-Certified Behavior Analyst (BCBA) | $13/15-minute unit ($52/hour)
| 6 hours per day |
Rate and Service Limit Increases
| Code | Description | Current Rate per Unit | Rate per Unit Beginning July 1, 2023 |
|---|---|---|---|
| 97153 | Adaptive Behavior Treatment by Protocol, performed by a Registered Behavioral Technician (RBT) | $11.25/15-minute unit ($45/hour)
| $14.88/15-minute unit ($59.52/hour) |
| Code | Description | Current Rate per Unit | Rate per Unit Beginning July 1, 2023 |
|---|---|---|---|
| 97156 | Family Adaptive Behavior Treatment Guidance | 48 units per year (15-minute units) | 96 units per year (15-minute units) |
Providers should direct any questions related to this bulletin to the Provider Service Center (PSC) at (888) 289-0709 or to behavioralhealth004@scdhhs.gov. The PSC’s hours of operation are 7:30 a.m. - 5 p.m. Monday - Thursday and 8:30 a.m. - 5 p.m. Friday.
South Carolina’s Medicaid managed care organizations (MCO) are responsible for the coverage and reimbursement related to the services described in this bulletin for Healthy Connections Medicaid members who are enrolled in an MCO.
Thank you for your continued support of the South Carolina Healthy Connections Medicaid program.