Public Notice of Final Action for the Addition of Autism Spectrum Disorder (ASD)
The South Carolina Department of Health and Human Services (SCDHHS) gives notice of the following actions regarding the addition of covered codes for ASD services under the State Plan under Title XIX of the Social Security Act Medical Assistance Program (Medicaid).
SCDHHS will add the following new ASD procedure codes effective for dates of service on or after July 1, 2024:
| Service Code | Service Description |
Provider Type |
Rate | |
| 97152 | Behavior Identification Supporting Assessment | Behavior identification supporting assessment, administered by one technician under the direction of a physician or other qualified health care professional, face-to-face with the patient, each 15 minutes. | Registered Behavior Therapist (RBT) | $20.50 21 units/day |
| 97157 | Multi-Family Group Adaptive Behavior Treatment Guidance | Multiple-family group adaptive behavior treatment guidance, administered by physician or other qualified health care professional (without the patient present), face-to-face with multiple sets of guardians/caregivers, each 15 minutes | Board-certified Behavior Analyst (BCBA) | $13.31 16 units/day |
| 0362T | Behavior Identification Supporting Assessment, 2 or more Technicians | Behavior identification supporting assessment, each 15 minutes of technicians' time face-to-face with a patient, requiring the following components:
| BCBA, Board-certified Assistant Behavior Analyst (BCaBA), RBT | $27.95 16 units/day (based on time elapsed, not total time per each technician) |
| 0373T | Adaptive Behavior Treatment, 2 or more Technicians | Adaptive behavior treatment with protocol modification, each 15 minutes of technicians' time face-to-face with a patient, requiring the following components:
| BCBA, BaCBA, RBT $30 32 units/day (based on time elapsed, not total time per each technician) | |
SCDHHS is making these changes to support access to behavioral health services, enhance the state's provider network, and ensure services are delivered effectively.
Based on the actions above, SCDHHS projects a budget impact of approximately $1.4 million (total dollars) per year.
Copies of this notice are available at each South Carolina Healthy Connections Medicaid county office and at www.scdhhs.gov for public review. Additional information regarding these actions is available upon request at the address cited below.
Any written comments submitted may be reviewed by the public at SCDHHS, Bureau of Policy, 1801 Main Street, Columbia, South Carolina, Monday through Friday between the hours of 9 a.m. and 5 p.m.