UPDATED Department of Alcohol and Other Drug Abuse Services Provider Fee Schedule Information in the Rate Increases Section: Rate Increases, Update of Covered Codes and Addition of Qualified Provider Type
UPDATE: The provider fee schedule information has been updated in the Rate Increases section of this bulletin.
Effective for dates of service on or after July 1, 2023, the South Carolina Department of Health and Human Services (SCDHHS) will increase reimbursement rates for certain services rendered by county substance use disorder authorities, update certain existing service codes and add a qualified provider type. These changes will support increased access to substance use disorder treatment services, enhance the state’s provider network and improve effective service delivery.
Rate Increases
SCDHHS is increasing reimbursement rates for the codes listed below. These rates will be updated in the Department of Alcohol and Other Drug Abuse Services (DAODAS) provider fee schedule by July 1, 2023.
| Code | Description | Current Rate per Unit: | Rate per Unit On/After July 1, 2023: |
|---|---|---|---|
| 90792 | Psychiatric Diagnostic Evaluation with Medical Services | Specialty Physician: $145.83 Physician/ Team Member Service: $68.54 Nurse Practitioner: $48.12 | Specialty Physician: $174.63 Physician/ Team Member Service: $116.90 Nurse Practitioner: $116.90 |
| 90833 | Psychotherapy with Patient with Evaluation and Management – 30 minutes | Specialty Physician: $56.06 Physician/ Team Member Service: $24.92 Nurse Practitioner: $17.50 | Specialty Physician: $97.02 Physician/ Team Member Service: $64.95 Nurse Practitioner: $64.95 |
| Code | Description | Current Rate per Unit: | Rate per Unit On/After July 1, 2023: |
| 90836 | Psychotherapy with Patient with Evaluation and Management – 45 minutes | Specialty Physician: $73.57 Physician/ Team Member Service: $34.58 Nurse Practitioner: $24.28 | Specialty Physician: $174.30 Physician/ Team Member Service: $116.90 Nurse Practitioner: $116.90 |
| 96372 | Therapeutic, Prophylactic, and Diagnostic Injections and Infusions (Intramuscular) | $3.88 | $12.97 |
| 99203 - AF | Evaluation and Management, New Outpatient, Level 3 | $67.37 | $80.29 |
| 99213 - AF | Evaluation and Management, Established Outpatient Level 3 | $45.37 | $58.11 |
| H0038 | Peer Services, Individual, per 15 minutes | $10.76 | $13.24 |
| H0038 - HQ | Peer Services, Group | $1.79 | $2.32 |
| S9482 | Family Stabilization Services | $6.16 | $15.13 |
Updated Codes
SCDHHS will update psychological testing codes, which includes replacing a retired Centers for Medicare and Medicaid Services code. These services will be added to the DAODAS section of the RBHS Provider manual by July 1, 2023. Reimbursement rates for these services will be added to the RBHS-DAODAS provider fee schedules available on SCDHHS’ website by July 1, 2023.
The retired code (96101) is replaced by two codes (96130 and 96136) for initial units of service, and two new codes (96131 and 96137) are provided for additional units of service.
| Updated Code | Description | Rate | Service Limit |
|---|---|---|---|
| 96130 (replaces 96101) | Psychological Test Administration/Scoring, Initial Hour | $90.43 |
1 per day/24 per 12 months
|
| 96131 (new) | Psychological Test Administration/Scoring, Additional Hour | $90.43 |
5 per day/24 per 12 months
|
| 96136 (replaces 96101) | Psychological or Neuropsychological Test Administration/Scoring (Two or More), Initial 30 Minutes | $45.21 |
1 per day/24 per 12 months
|
| Updated Code | Description | Rate | Service Limit |
| 96137 (new) | Psychological or Neuropsychological Test Administration/Scoring (Two or More), Additional 30 Minutes | $45.21 |
5 per day/24 per 12 months
|
Addition of Qualified Provider Type
Licensed addiction counselors will be added to the list of qualified providers in the Staff Qualifications section of the State Plan for provision of Medicaid mental health and/or substance use disorder services in accordance with South Carolina state law.
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.
South Carolina’s Medicaid managed care organizations (MCO) are responsible for the coverage and reimbursement related to the services described in this bulletin for Healthy Connections Medicaid members who are enrolled in an MCO.
Redesigned SCDHHS Website
SCDHHS is excited to announce the launch of the agency’s redesigned website. The agency’s URL will remain www.scdhhs.gov, but users will notice a new look and feel to the website. This includes several features that improve the overall usability and brings it in line with leading public agency website industry standards. Read more about the redesigned site here.
Thank you for your continued support of the South Carolina Healthy Connections Medicaid program.