Public Notice of Final Action for Rate Increases for Certain Incontinence Supplies, DAODAS and ASD Services

The South Carolina Department of Health and Human Services (SCDHHS) gives notice of the following actions regarding rate increases for certain incontinence supplies, Department of Alcohol and Other Drug Abuse Services (DAODAS) providers, autism spectrum disorder (ASD) services, and peer support services under the State Plan under Title XIX of the Social Security Act Medical Assistance Program (Medicaid).

Effective for dates of service on or after Jan. 1, 2022, the rates for incontinence supplies billed using Healthcare Common Procedure Coding System (HCPCS) codes A4554, T4521, T4522, T4523, T4524, T4525, T4526, T4527, T4528, T4529, T4530, T4531, T4532, T4533, T4534, T4535, T4543, and T5999 will increase by 10%. This change is reflected in the Durable Medical Equipment (DME) fee schedule and the Community Long Term Care (CLTC) fee schedule available on SCDHHS’ website.

Effective for dates of service on or after Jan. 1, 2022, the rates for DAODAS services billed using HCPCS codes H0001 (with modifiers HO, HN, TS, UC, TD, and U2), H0004, H0011, and H0015 will increase by 15%. This change is reflected in the DAODAS fee schedule.

Effective for dates of service on or after Jan. 1, 2022, the rate for DAODAS peer support services billed using HCPCS code H0038 will increase to $10.74. The rate for the HQ modifier will be $1.79. These changes are reflected in the DAODAS fee schedule.

Effective for dates of service on or after Jan. 1, 2022, the hourly rate for ASD services billed using the Current Procedural Terminology (CPT) code 97153 will increase to $45 and the rate for codes 97155 and 97156 will increase to $85. These changes are reflected in the ASD fee schedule.

Based on the actions above, SCDHHS anticipates a budget impact of approximately $10.6 million (total dollars) primarily due to beneficiaries’ estimated expenditures.

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 the SCDHHS, Bureau of Policy, 1801 Main Street, Columbia, South Carolina, Monday through Friday between the hours of 9 a.m. and 5 p.m.