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COVID-19 Telehealth Policy Update to Physician, NP and PA Evaluation and Management Coverage


Coronavirus Disease 2019 (COVID-19) Update to Temporary Telehealth Coverage Changes

On Friday, March 13, 2020, President Donald Trump declared a national emergency due to the 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 announced in the Medicaid bulletin issued on March 19, 2020.

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 April 1, 2020, for dates of service on or after March 23, 2020.

Evaluation and Management (E/M) via Telehealth  When rendered by a physician, nurse practitioner, or physician assistant, E/M services in the range of Current Procedural Terminology (CPT) codes 99202- 99204 and 99212-99214 may be provided regardless of the Medicaid member’s location. All aspects of the SCDHHS telemedicine policy continue to apply, except for the following:

  • Requirements related to the referring site are waived, and services may be provided without regard to the member’s location.
  • Requirements that a certified or licensed professional be present at the referring site are waived.
  • The audio and visual components of the interaction must include sufficient quality and/or resolution for the provider to effectively deliver the care being administered. Otherwise, any specific technology requirements are waived.

General standards regarding documentation and medical necessity continue to apply. Services billed pursuant to this benefit expansion should be billed with a GT modifier.

The information contained in this bulletin does not apply to telehealth delivered by Federally Qualified Health Centers (FQHCs) or Rural Health Clinics (RHCs), and additional guidance for these providers will be communicated in a separate, forthcoming provider bulletin(s).

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

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