Pediatric Screening (CPT) 96127

Effective Nov. 1, 2016, the South Carolina Department of Health and Human Services (SCDHHS) will limit payment for Current Procedural Terminology (CPT) code 96127 to a maximum of two units per date of service. This is consistent with the National Correct Coding Initiative (NCCI) Medically Unlikely Edit (MUE) limit for this service. This bulletin supersedes previous SCDHHS guidance, provided March 31, 2015, indicating that a maximum of four units are payable per date of service for CPT code 96127.

If you have any questions regarding this bulletin, please contact the SC Provider Service Center at 1 (888) 289-0709. Thank you for your continued support of the South Carolina Healthy Connections Medicaid Program.

Report Fraud