Rate Increases for Services Provided by Master’s-level Practitioners and Licensed Psychologists in Private Organizations
Effective July 1, 2024, the South Carolina Department of Health and Human Services (SCDHHS) will increase reimbursement rates for core rehabilitative behavioral health services provided by private, master's degree-level practitioners and licensed psychologists through the Medicaid State Plan.
The services impacted by this rate increase, denoted with an HO (master's level) or AH (licensed psychologist) modifier depending on provider type, are included in the table below.
| Procedure Code | Service Definition | Current RBHS Rates | Current LIP Rates | Rates for RBHS and LIP effective July 1, 2024 |
|---|---|---|---|---|
| 90791 | Diagnostic Assessment | HO = $153.94 | HO = $153.94 | HO = $161.55 |
| AH = $224.63 | AH = $224.63 | AH = $235.86 | ||
| 90832 | Individual Psychotherapy - 30 min. | HO = $37.30 | HO = $37.30 | HO = $39.14 |
| AH = $54.43 | AH = $54.43 | AH = $57.15
| ||
| 90834 | Individual Psychotherapy - 45 min. | HO = $74.60 | HO = $74.60 | HO = $78.29 |
| AH = $108.86 | AH = $108.86 | AH = $114.30 | ||
| 90837 | Individual Psychotherapy - 60 min. | HO = $111.90 | HO = $111.90 | HO = $117.43 |
| AH = $163.29 | AH = $163.29 | AH = $171.45 | ||
| 90846 | Family Psychotherapy Without Patient - 50 min. | HO = $107.04 | HO = $107.04 | HO = $112.32 |
| AH = $156.18 | AH = $156.18 | AH = $163.99 | ||
| 90847 | Family Psychotherapy With Patient - 50 min. | HO = $107.04 | HO = $107.04 | HO = $112.32 |
| AH = $156.18 | AH = $156.18 | AH = $163.99 | ||
| 90853 | Group Psychotherapy | HO = $16.65 | HO = $16.65 | HO = $17.48 |
| AH = $24.30 | AH = $24.30 | AH = $25.52 | ||
| H0031 | Mental Health Comprehensive Assessment - Follow-up | HO = $76.97 | HO = $71.58 | HO = $80.78 |
| AH = $112.32 | AH = $104.46 | AH = $117.94 | ||
| H0032 | Mental Health Service Plan Development | HO = $8.04 | N/A | HO = $8.44 (RBHS only) |
| AH = $11.73 | N/A | AH = $12.32 (RBHS only) | ||
| H2011 | Crisis Management | HO = $19.39 | HO = $18.03 | HO = $20.35 |
| AH = $28.29 | AH = $26.31 | AH = $29.70 |
The procedure codes with rates being increased can also be found in the Rehabilitative Behavioral Health Services (RBHS) fee schedule available on SCDHHS' website and the Procedure Codes section included with the Licensed Independent Practitioners (LIP) Rehabilitative Services manual. Both documents will be updated by July 1, 2024, to reflect the increased rates for these services.
This change in reimbursement rate does not apply to services provided by state agencies or entities working on behalf of a state agency.
South Carolina's Medicaid managed care organizations (MCOs) are responsible for the authorizations, coverage and reimbursement related to the services described in this bulletin for Healthy Connections Medicaid members who are enrolled in an MCO.
Providers should direct questions related to this bulletin to the Provider Service Center (PSC) at (888) 289-0709 or to behavioralhealth004@scdhhs.gov. The PSC's hours of operations are 7:30 a.m.-5 p.m. Monday-Thursday and 8:30 a.m.-5 p.m. Friday.
Thank you for your continued support of the South Carolina Healthy Connections Medicaid program.