Final Action for Professional Service Fee Schedules

The South Carolina Department of Health and Human Services (SCDHHS) gives notice of the following action regarding professional service fee schedules under the State Plan under Title XIX of the Social Security Act Medical Assistance Program (Medicaid).

Effective for dates of service on and after July 1, 2019, SCDHHS will amend the South Carolina Title XIX State Plan to update the fee schedule for providers indicated below. 

SCDHHS will transition from the 2009 to the 2019 Medicare fee schedule as a basis for determining Medicaid reimbursement. Base Medicaid rates will be set at 78% of the Medicare fee schedule for evaluation, preventative care and diagnostic services. Base Medicaid rates will be set at 71% of the Medicare fee schedule for all other services. Providers who currently participate in the Enhanced Physician Fee Schedule program will be reimbursed at 129% of the base Medicaid rate. Neonatologists and pediatric subspecialists will be reimbursed at 140% of the base Medicaid rate. Rates for durable medical equipment (DME), where the rate is determined based on Medicare rates, will be updated to 100% of the 2019 Medicare Durable Medical Equipment, Prosthetics/Orthotics and Supplies (DMEPOS) non-rural fee schedule. Rates not based on the Medicare rates, including respiratory and enteral nutrition services, will remain at the current rate.

In the aggregate, these actions will result in an increase in provider reimbursement. SCDHHS projects that annual aggregate Medicaid expenditures will increase by approximately $16,300,000 (total dollars).

Copies of this notice are available at each SCDHHS Healthy Connections Medicaid office and at scdhhs.gov for public review. Additional information regarding this action is available upon request at the address cited below.

Any written comments submitted may be reviewed by the public at the SCDHHS, Division of Coverage and Benefit Design, Jefferson Square Building, 1801 Main Street, Columbia, South Carolina, Monday through Friday between 9 a.m.-5 p.m.