UPDATE to Addition of New Covered Autism Spectrum Disorder Services
This bulletin serves as an update to Medicaid Bulletin MB# 24-024. MB# 24-024 announced the South Carolina Department of Health and Human Services (SCDHHS) will add coverage of additional autism spectrum disorder (ASD) services effective for dates of service on or after July 1, 2024. However, the bulletin included an incorrect service limit for procedure code 97152. Effective July 1, 2024, the service limit for procedure code 97152 will be 21 units/day. A correction has been added to the posting of MB# 24-024 on SCDHHS' website and an updated table of new ASD services and their reimbursement rates is available below.
| Code | Description | Provider Type | Rate per Unit |
|---|---|---|---|
| 97152 | Behavior identification supporting assessment, administered by one technician under the direction of a physician or other qualified health care professional, face-to-face with the patient. | Registered Behavior Therapist (RBT) |
$20.50 per 15 min. unit *Service limit: 21 units/day *Note this a correction from the service limit originally announced in MB# 24-024. |
| 97157 | Multiple-family group adaptive behavior treatment guidance, administered by physician or other qualified health care professional (without the patient present), face-to-face with multiple sets of guardians/caregivers. |
Board-certified Behavior Analyst (BCBA) |
$13.31 per 15 min. unit Service limit: 16 units/day |
| 0362T | Behavior identification supporting assessment, administered by two or more technicians, face-to-face with a patient, requiring the following components:
|
BCBA, Board-certified Associate Behavior Analyst (BCaBA), RBT |
$27.95 per 15 min. unit Service limit: 16 units/day Based on total time elapsed, not total time per each technician; service is billed by the physician or other qualified health care professional directing the session. |
| 0373T | Adaptive behavior treatment with protocol modification, administered by two or more technicians, face-to-face with a patient, requiring the following components:
|
BCBA, BCaBA, RBT |
$30 per 15 min. unit Service limit: 32 units/day Based on total time elapsed, not total time per each technician; service is billed by the physician or other qualified health care professional directing the session. |
South Carolina's Healthy Connections 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 any 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.