Clinic Services Policy Updates for Oct. 1, 2023
The South Carolina Department of Health and Human Services (SCDHHS) is announcing policy updates that affect clinic service providers effective for dates of service on or after Oct. 1, 2023.
Dialysis for Acute Kidney Injury (AKI) in End Stage Renal Disease (ERSD) Clinics
SCDHHS will reimburse ESRD clinics for dialysis treatment for full-benefit Healthy Connections Medicaid members with AKI. Providers must use the CPT code 90935 and an AKI ICD-10 diagnosis code. Reimbursement for this code follows the current State Plan reimbursement methodology established for ESRD clinics and is an all-inclusive rate for equipment, laboratory testing, oral vitamins, nutritional supplements, minerals, phosphate binders, antacids and staff time. The reimbursement rate and criteria and limitations for this code are shown below.
| Procedure Code | Description | Criteria and Limitations | Reimbursement Rate |
|---|---|---|---|
| 90935 | Hemodialysis procedure with single evaluation by a physician or other qualified health care professional | Allowed one per day per patient; claim must indicate at least one of the AKI ICD-10 diagnosis codes. | $113.09 |
Preventive Screening Services and Immunizations
Clinic providers must follow the United States Preventive Services Task Force (USPSTF) grade A and B recommendations that are applicable to their clinic setting when providing screenings to full-benefit Healthy Connections Medicaid members. These recommendations are available on USPSTF's website.
Clinic providers must follow the Advisory Committee on Immunization Practices’ (ACIP) recommendations on vaccines for both children and adults when administering vaccines applicable to their clinic settings to full benefit Healthy Connections Medicaid Members. These recommendations are available on ACIP’s website. All child and adult vaccines are covered without cost-sharing.
South Carolina Healthy Connections Medicaid managed care organizations (MCOs) are responsible for the coverage and reimbursement of services described in this bulletin for members enrolled in an MCO.
The Clinic Services provider manual will be updated by Oct. 1, 2023, to reflect these changes.
Providers should direct any questions related to this bulletin to the Provider Service Center (PSC). PSC representatives can be reached at (888) 289-0709 from 7:30 a.m.-5 p.m. Monday-Thursday and 8:30 a.m.-5 p.m. Friday. Providers can also submit an online inquiry at: https://www.scdhhs.gov/providers/contact-provider-representative.
Thank you for your continued support of the South Carolina Healthy Connections Medicaid program.