Physician Fee Schedule Rate Increase
The South Carolina Department of Health and Human Services (SCDHHS) is increasing the rates for the following State Plan physician services for dates of service on or after July 1, 2023. These rates listed below apply only to evaluation and management (E/M) for well and sick visits of established patients.
The Medicaid base rates for these E/M visits will be set at 82% of the 2019 Medicare fee schedule and will apply to the calculations for the advanced practice providers’ rates and the qualifying providers’ enhanced rates as indicated in the State Plan respectively.
| Procedure Code | Short Description | Current Base Rate | New Base Rate |
|---|---|---|---|
| 99211 | Office or other outpatient visit for the evaluation and management of an established patient | $16.75 | $17.61 |
| 99212 | Office or other outpatient visit for the evaluation and management of an established patient, 10-19 minutes of total time is spent on the date of the encounter | $33.34 | $35.06 |
| 99213 | Office or other outpatient visit for the evaluation and management of an established patient, 20-29 minutes of total time is spent on the date of the encounter | $55.27 | $58.11 |
| 99214 | Office or other outpatient visit for the evaluation and management of an established patient, 30-39 minutes of total time is spent on the date of the encounter | $81.15 | $85.31 |
| 99215 | Office or other outpatient visit for the evaluation and management of an established patient, 40-54 minutes of total time is spent on the date of the encounter. | $108.82 | $114.40 |
| 99391 | Periodic comprehensive preventive medicine reevaluation and management of an established patient; infant (age younger than 1 year) | $74.88 | $78.72 |
| 99392 | Periodic comprehensive preventive medicine reevaluation and management of an established patient; early childhood (age 1 through 4 years) | $79.97 | $84.07 |
| 99393 | Periodic comprehensive preventive medicine reevaluation and management of an established patient; late childhood (age 5 through 11 years) | $79.71 | $83.80 |
| 99394 | Periodic comprehensive preventive medicine reevaluation and management of an established patient; adolescent (age 12 through 17 years) | $87.54 | $92.03 |
| 99395 | Periodic comprehensive preventive medicine reevaluation and management of an established patient; 18-39 years | $89.46 | $94.05 |
| State Plan E/M Physician Services | ||||||||
| Procedure Code | Current Base Rate | New Base Rate | Current Advanced Practitioner Rate | Advanced Practitioner New Rate | Current Enhanced Rate Primary Care | New Enhanced Rate Primary Care | Current Enhanced Rate Pediatric Subspecialty | New Enhanced Rate Pediatric Subspecialty |
| 99211 | $16.75 | $17.61 | $13.4 | $14.09 | $21.61 | $22.73 | $23.45 | $24.66 |
| 99212 | $33.34 | $35.06 | $26.67 | $28.05 | $43.01 | $45.23 | $46.68 | $49.09 |
| 99213 | $55.27 | $58.11 | $44.22 | $46.49 | $71.30 | $74.96 | $77.38 | $81.35 |
| 99214 | $81.15 | $85.31 | $64.92 | $68.25 | $104.68 | $110.05 | $113.61 | $119.44 |
| 99215 | $108.82 | $114.40 | $87.05 | $91.52 | $140.37 | $147.57 | $152.34 | $160.16 |
| 99391 | $74.88 | $78.72 | $59.9 | $62.97 | $96.59 | $101.55 | $104.83 | $110.21 |
| 99392 | $79.97 | $84.07 | $63.98 | $67.26 | $103.16 | $108.45 | $111.96 | $117.70 |
| 99393 | $79.71 | $83.80 | $63.77 | $67.04 | $102.83 | $108.11 | $111.60 | $117.33 |
| 99394 | $87.54 | $92.03 | $70.03 | $73.62 | $112.93 | $118.72 | $122.56 | $128.85 |
| 99395 | $89.46 | $94.05 | $71.57 | $75.24 | $115.4 | $121.32 | $125.24 | $131.66 |
The updated base physician rates and enhanced physician rates for the above procedure codes are published on the Base Physician, Enhanced Physician and Pediatric Subspecialty and Neonatology Fee schedules respectively. These fee schedules are available on SCDHHS’ website and will be updated by July 1, 2023.
Providers should direct 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: http://www.scdhhs.gov/contact-us.
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.
Redesigned SCDHHS Website
SCDHHS is excited to announce the launch of the agency’s redesigned website. The agency’s URL will remain www.scdhhs.gov, but users will notice a new look and feel to the website. This includes several features that improve the overall usability and brings it in line with leading public agency website industry standards. Read more about the redesigned site here.
Thank you for your continued support of the South Carolina Healthy Connections Medicaid program.