Rate Increases for Certain Incontinence Supplies and DAODAS and ASD Services
Effective Jan. 1, 2022, the South Carolina Department of Health and Human Services (SCDHHS) will increase the reimbursement rates for the services and supplies mentioned below. These rate increases apply to the Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes included in this bulletin.
Incontinence Supplies
SCDHHS will increase the reimbursement rates for incontinence supplies billed using the HCPCS codes listed below by 10%.
| Code | Description |
|---|---|
| A4554 | Disposable Underpads, All Sizes |
| T4521 | Adult Size, Brief/Diaper - S |
| T4522 | Adult Size, Brief/Diaper - M |
| T4523 | Adult Size, Brief/Diaper - L |
| T4524 | Adult Size, Brief/Diaper - XL |
| T4525 | Adult Size, Protective Underwear/Pull On - S |
| T4526 | Adult Size, Protective Underwear/Pull On - M |
| T4527 | Adult Size, Protective Underwear/Pull On - L |
| T4528 | Adult Size, Protective Underwear/Pull On - XL |
| T4529 | Pediatric Size, Brief/Diaper - S/M |
| T4530 | Pediatric Size, Brief/Diaper - L |
| T4531 | Pediatric Size, Protective Underwear/Pull On - S/M |
| T4532 | Pediatric Size, Protective Underwear/Pull On - L |
| T4533 | Youth Size, Brief/Diaper |
| T4534 | Youth Size, Protective Underwear/Pull On |
| T4535 | Disposable Liner/Shield/Guard/Pad/Undergarment |
| T4543 | Adult Size, Brief/Diaper, Bariatric, XXL |
| T5999 | Supply, Not Otherwise Specified |
These changes will be reflected in the Durable Medical Equipment (DME) and the Community Long Term Care (CLTC) fee schedules available on SCDHHS’ website by Jan. 1, 2022.
Department of Alcohol and Other Drug Abuse Services (DAODAS) Services
SCDHHS will increase the reimbursement rates for addiction services billed using the HCPCS codes listed below by 15%.
| Code | Description |
|---|---|
| H0001 (with modifiers HO, HN, TS, UC, TD andU2) | Alcohol & Drug Assessment |
| H0004 (with modifier GT) | Individual Alcohol/Drug Substance Abuse Counseling |
| H0011 | Alcohol/Drug Services Detox Residential |
| H0015 | Alcohol/Drug Services Intensive OP Treatment Level II.i (hourly) |
SCDHHS will also update the reimbursement rates as depicted below for DAODAS peer support services billed using the following HCPCS code:
| Code | Description | New Rate |
|---|---|---|
| H0038 | Individual | $10.74 |
| H0038 (with modifier HQ) | Group | $1.79 |
These changes will be reflected in the DAODAS fee schedule available on SCDHHS’ website by Jan. 1, 2022.
Autism Spectrum Disorder (ASD) Services
SCDHHS will update the reimbursement rates as depicted below for ASD services billed using the following CPT codes:
| Code | Description | New Rate |
|---|---|---|
| 97153 | Treatment - RBT | $45/hour |
| 97155 | Treatment - BCBA/BCaBA | $85/hour |
| 97156 | Family Training | $85/hour |
These changes will be reflected in the ASD fee schedule available on SCDHHS’ website by Jan. 1, 2022.
Providers with questions regarding this bulletin should contact the SCDHHS Provider Service Center at (888) 289-0709. The Provider Service Center’s hours of operations are 7:30 a.m.-5 p.m. Monday-Thursday and 8:30 a.m.-5 p.m. Friday.