COVID-19 Telehealth Policy Update to New Patient and Associate and Assistant-level Provider Coverage
On Friday, March 13, 2020, President Donald Trump declared a national emergency due to coronavirus disease 2019 (COVID-19) and Governor Henry McMaster declared a state of emergency for the state of South Carolina. As a part of the state’s preparation and response to COVID-19, the South Carolina Department of Health and Human Services (SCDHHS) is announcing additional temporary modifications to policies related to telehealth coverage. These modifications are in addition to those previously announced that are available at www.scdhhs.gov/COVID19.
The policy changes outlined below will remain in effect for the duration of the current declared public health emergency, unless SCDHHS determines they should sunset at an earlier date. SCDHHS will begin accepting claims for these policy changes beginning May 1, 2020, for dates of service on or after the date of this bulletin.
Care Provided to New Patients via Telehealth
Initial guidance on some telehealth flexibilities focused on expanding SCDHHS coverage to established patients. To facilitate patient care as the period of the COVID-19 response and recommended social distancing standards has increased, SCDHHS will reimburse for the services listed below when provided to a new patient.
| Service Description | Billing Codes | Initial Bulletin |
|---|---|---|
| Telehealth services provided by a physician, nurse practitioner or physician assistant | 99202, 99203, 99204 | 20-004 20-005 |
| Telehealth services provided by Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) | 99202, 99203, 99204 | 20-007
|
| Telehealth services provided by physical, occupational and speech therapists | 97530, 97110, 92507, for services described in bulletin 20-008 | 20-008 |
| Services provided by licensed independent behavioral health practitioners and related associate-level providers | 90832, 90834, 90837, 90846, 90847, 90791, H2014, H2017, S9482 | 20-009 20-014 |
The bulletins referenced in the table above are available at www.scdhhs.gov/COVID19 and are also directly linked here: 20-004, 20-005, 20-007, 20-008, 20-009, 20-014.
All other requirements, limitations and billing guidelines articulated in the initial bulletins continue to apply. SCDHHS standards for authorization and referral, service limits and standards of medical necessity must be satisfied prior to initiation of care for a new patient.
Telehealth Coverage for Services Provided by Physical, Occupational and Speech Therapy Assistants
As described in bulletin 20-008, SCDHHS has extended telehealth flexibilities to physical, occupational and speech therapists for the provision of specific services. To ensure continued access to care for South Carolina Health Connections Medicaid members, SCDHHS is extending those flexibilities. SCDHHS will reimburse for the services described in bulletin 20-008 when care is provided by physical therapy assistants, occupational therapy assistants, speech pathology interns or speech pathology assistants. Services must be provided in a manner that is consistent with relevant practice acts, supervision requirements and standards of care. Authorization requirements, service limits and standards for medical necessity continue to apply.
Telehealth Coverage for Licensed Master Social Worker (LMSW)
SCDHHS will reimburse for services provided by LMSWs in the same manner as associate-level providers described in bulletin 20-014. Authorization requirements, service limits and standards for medical necessity continue to apply.
Additional guidance regarding coverage policy will be communicated in future bulletins as needed. Providers are encouraged to view the resources, including responses to frequently asked questions, available at www.scdhhs.gov/covid19 and submit questions about COVID-19-related policy changes to covid@scdhhs.gov.
Thank you for your continued support of the South Carolina Healthy Connections Medicaid program.