Public Notice of Final Action for Setting Payment Rates for Rehabilitative Occupational, Physical and Speech Therapy Services
The South Carolina Department of Health and Human Services (SCDHHS) gives notice of the following actions regarding its methods and standards for setting payment rates for rehabilitative occupational, physical, and speech therapy services under the State Plan under Title XIX of the Social Security Act Medical Assistance Program (Medicaid).
Effective for services provided on or after July 1, 2024, SCDHHS will amend the South Carolina Title XIX State Plan to update the reimbursement methodology rates for the State Plan covered rehabilitative occupational, physical, and speech therapy services as follows:
- Reimbursement for occupational and physical therapy services will be set at 83% of the 2024 Medicare Physician Fee Schedule. Reimbursement for certain general therapy treatment will be set at 70% of the 2024 Medicare Physician Fee Schedule.
- Reimbursement for speech therapy services will be set at 83% of the 2024 Medicare Physician Fee Schedule. Reimbursement for time-based speech therapy services will remain unchanged.
| Physical Therapy | Occupational Therapy | Speech-Language Pathology | ||||||||
| Code | Current Rate | New rate | Code | Current Rate | New rate | Code | Current Rate | New rate | ||
| 97022 | $11.30 | $14.09 | 97022 | $11.30 | $14.09 | 92521 | $70.80 | $110.24 | ||
| 97110 | $21.84 | $24.31 | 97110 | $21.84 | $24.31 | 92522 | $57.67 | $92.28 | ||
| 97112 | $27.10 | $27.90 | 97112 | $27.10 | $27.90 | 92523 | $119.49 | $188.98 | ||
| 97113 | $26.36 | $30.39 | 97113 | $26.36 | $30.39 | 92524 | $59.05 | $90.90 | ||
| 97140 | $20.10 | $22.38 | 97140 | $20.10 | $22.38 | 92526 | $42.52 | $71.01 | ||
| 97150 | $13.84 | $14.92 | 97150 | $13.84 | $14.92 | 92606 | $64.80 | $64.93 | ||
| 97161 | $49.04 | $83.17 | 97165 | $48.18 | $83.99 | 92607 | $101.41 | $102.78 | ||
| 97162 | $49.04 | $83.17 | 97166 | $48.18 | $83.99 | 92608 | $40.71 | $40.71 | ||
| 97163 | $49.04 | $83.17 | 97167 | $48.18 | $83.99 | 92609 | $51.69 | $85.65 | ||
| 97164 | $32.37 | $57.74 | 97168 | $31.14 | $58.02 | 92610 | $52.96 | $70.73 | ||
| 97530 | $23.14 | $25.63 | 97530 | $23.14 | $25.63 | S9152 | $54.59 | $61.68 | ||
| 97760 | $19.51 | $39.51 | 97760 | $19.51 | $39.51 | |||||
| 97763 | $36.67 | $43.38 | 97763 | $36.67 | $43.38 | |||||
| L2999 | $93.36 | $100.39 | L2999 | $93.36 | $100.39 | |||||
| L3808 | $47.46 | $51.03 | L3808 | $47.46 | $51.03 | |||||
| L3999 | $34.78 | $37.40 | L3999 | $34.78 | $37.40 | |||||
These rate changes apply to individual or group rehabilitative occupational therapy, physical therapy or speech-language pathology providers; comprehensive outpatient rehabilitative facilities; and local education agencies.
SCDHHS is updating rates to support the provider network and ensure access to care for these services.
Based on the actions above, SCDHHS anticipates a budget impact of approximately $4 million in 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 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.