Convenient Care Clinics Provider Enrollment and Place of Service Code 17



Effective with dates of service on or after August 1, 2012, the South Carolina Department of Health and Human Services (SCDHHS) provider enrollment policy will now allow Convenient Care Clinics (CCC) to enroll as a provider group for billing purposes. CCC’s are located in retail stores, supermarkets and pharmacies and are able to treat uncomplicated minor illnesses and provide preventative healthcare services.  They are often referred to as retail clinics, retail-based clinics or walk-in medical clinics.


The CCC’s must bill Medicaid using the Place of Service (POS) code 17 as defined by the American Medical Association Current Procedural Terminology for a walk-in retail health clinic.  Covered services for this POS are limited to episodic care and wellness/preventative services.  Wellness/preventative services are covered for recipients five (5) years of age and older and are clearly outlined in the Physicians, Laboratories, and Other Medical Professionals manual located on our website at Episodic care includes minor illness exams/treatment to include but not limited to allergies, earaches, and sore throats, and minor injury exams/treatment to include but not limited to blisters, burns, and bug bites.


In order to maintain the Primary Care Medical Home model, the CCC must provide information regarding any service performed in the CCC to the recipient’s primary care physician (PCP) for both fee-for-service and the Medical Home Networks (MHNs).  The MHNs will be advised that a referral number for approval of payment should not be issued until this information is received.  The CCC is required to send information regarding a service to the PCP by facsimile within 24 hours of the visit and maintain confirmation of receipt of the facsimile in the patient’s file. As with many services provided to Managed Care Plan (MCP) members, services performed by any provider other than the primary care physician may require prior approval and/or referral from the PCP.  Please contact the appropriate Managed Care Organization (MCO) for their coverage policy. 


SCDHHS will maintain an active list of enrolled POS providers on our website.  Please refer any questions regarding this bulletin to the SCDHHS Provider Service Center at 1-888-289-0709.  Thank you for your continued support of the South Carolina Healthy Connections Medicaid Program.

Report Fraud