Modification to Codes that require Filing to TPL

Effective for dates of service on or after July 1, 2017, and as required by 1902(a) (25) of the Social Security Act, the South Carolina Department of Health and Human Services (SCDHHS) will implement cost avoidance rules for the procedure codes reflected below. Service providers will be required to file claims to any liable third-party insurer before submitting a claim to SCDHHS for payment. Claims filed with SCDHHS prior to billing all liable third-party insurers and appropriately documenting the third party filing on the claim submitted to Medicaid will receive all applicable claim edits. Resolution of applicable claim edits for the issues described above are outlined in the appendices of each SCDHHS provider manual, located at https://www.scdhhs.gov/provider-manual-list .

Codes:  

90460

92592

97530

99393

T1013

V5090

90461

97001

99241

99394

T1016

V5264

90885

97161

99381

G9007

T1017

X8185

92507

97162

99382

H2019

T1023

X8186

92508

97163

99383

S8180

T1024

 

92552

97165

99384

S8185

T1025

 

92557

97166

99391

S9445

T1027

 

92590

97167

99392

S9446

V5011

 

              

This policy applies to audiologists, anesthesiologists, certified registered nurse Anesthetists and comprehensive outpatient rehabilitation facility providers.

Please refer any questions or concerns regarding this bulletin to the Provider Service Center at (888) 289-0709.

Thank you for your continued support of the South Carolina Healthy Connections Medicaid program.

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