Physicians Services Policy Updates for Oct. 1, 2023
The South Carolina Department of Health and Human Services (SCDHHS) is announcing changes to several policies and clarifying existing policies in the Physicians Services provider manual through this Medicaid bulletin. The policy changes described below are effective for dates of service on or after Oct. 1, 2023.
Mobile Optometry Services
Effective Oct. 1, 2023, SCDHHS will reimburse providers for optometry services delivered via mobile units as part of a nonprofit or not-for-profit program on site at Title I public schools to students enrolled in the school who are Healthy Connections Medicaid members. Providers must follow all statutes, regulations and policies regulating optometry practice in South Carolina.
There will be no changes to the vision benefit and reimbursement for vision services delivered in schools via mobile units will be the same as services delivered in an office setting. Providers must indicate the place of service as 03-school on the claim form for mobile optometry services. To be reimbursed for services by the Healthy Connections Medicaid program, providers must enroll as a Medicaid provider. Organizations can enroll through SCDHHS' website. Individual optometrists performing services through an organization must also enroll as an individual optometrist through the same page on SCDHHS' website. These enrollments can occur simultaneously.
Newborn Metabolic Screening
Effective for dates of service on or after Oct. 1, 2023, providers who collect specimens for a newborn metabolic screening in a birthing center or home birth setting will no longer be reimbursed by SCDHHS for the laboratory performance of the test. Providers must follow the guidance established in Section V of the Department of Health and Environmental Control's (DHEC) Public Health Laboratory Complete Services Guide for specimen submission and invoicing.
Preventive Screening Services and Immunizations
For preventive screening services for full-benefit Healthy Connections Medicaid members, SCDHHS follows the United States Preventive Services Task Force (USPSTF) grade A and B recommendations available on the USPSTF's website.
For immunizations for full benefit Healthy Connections Medicaid members, SCDHHS follows the Advisory Committee on Immunization Practices’ (ACIP) recommendations on vaccines for both children and adults available here. All vaccines are covered without cost-sharing.
The Physicians Services provider manual will be updated with the most recent preventative screening and immunizations by Oct. 1, 2023.
Pregnancy Visits SCDHHS is clarifying its current policy related to pregnancy visits by outlining two options providers can choose from to bill for an initial pregnancy visit.
- Providers may bill an initial visit for each pregnancy using the Current Procedural Terminology (CPT) evaluation and management (E/M) code. Under this option, a provider would bill for a new patient E/M code even if the Medicaid member is a patient of record at that practice. The claim must contain a pregnancy diagnosis code.
OR
- Providers may bill the appropriate E/M code that meets the CPT description for level of complexity when billing for initial or antepartum visits. The level of complexity must be documented in the patient’s medical record. The claim must contain a pregnancy diagnosis code.
SCDHHS is clarifying there is no visit limit in place for pregnancy or postpartum care for full-benefit Healthy Connections Medicaid members. Additionally, co-pays are currently suspended for all E/M codes until May 2024 as announced in Medicaid bulletin MB# 23-003.
South Carolina’s 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.
Updated policy language will be available in the Physicians Services provider manual by Oct. 1, 2023.
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.