Reimbursement Methodology for Pediatric HIV Clinics (Outpatient Pediatric AIDS Clinics)
Effective for dates of service on or after July 1, 2025, the South Carolina Department of Health and Human Services (SCDHHS) is updating the reimbursement methodology for services delivered in a Pediatric HIV Clinic (PHC), previously known as an Outpatient Pediatric AIDS Clinic. PHCs provide specialty care, consultation and counseling services for full-benefit Healthy Connections Medicaid members under the age of 21 at risk for or living with HIV.
These services will be reimbursed as shown below.
| Code | Description | Rate |
|---|---|---|
| T1015 | Clinic visit/encounter, all inclusive | $99 |
| T1025 | Intensive, extended multidisciplinary services with physician present, provided in a clinic setting to children with complex medical, physical, mental and psychosocial impairments, per diem | $1,031 |
SCDHHS is making this change to support access to PHC services, standardize reimbursement and improve Medicaid members' health outcomes. This change will be published in the Clinic Services Manual available on SCDHHS' website by July 1, 2025. The reimbursement rate will be published in a new fee schedule titled Pediatric HIV Clinics Fee Schedule that will be available on the Fee Schedules page of SCDHHS' website by July 1, 2025.
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 members enrolled in an MCO.
Providers should direct questions related to this bulletin to the Provider Service Center (PSC). PSC representatives can be reached at (888) 289-0709 from 7:30 a.m.-5 p.m. Monday-Thursday and 8:30 a.m.-5 p.m. Friday. Providers can also submit an online inquiry at https://www.scdhhs.gov/providers/contact-provider-representative.