Prostate Cancer Screenings Added to Limited Benefit Program

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The South Carolina Department of Health and Human Services (SCDHHS) today announced it will add coverage of prostate cancer screenings for members of the Family Planning limited benefit program beginning Aug. 1, 2021. For those who qualify through the limited benefit program, prostate cancer screenings for the following Current Procedural Terminology (CPT) codes will be covered:

  • 84153 (Prostate Specific Antigen [PSA])
  • G0102 (Prostate Cancer Screening, Digital Rectal Exam)
  • G0103 (Prostate Cancer Screening, PSA)

Services will be available consistent with the standards outlined by the United States Preventive Services Task Force.

SCDHHS’ Family Planning limited benefit program is available to individuals whose annual family income is at or below 194% of the federal poverty level (FPL). The limited benefit program provides coverage for limited medical services including some preventative health care services. Individuals interested in applying for or learning more about this limited benefit program can visit https://scdhhs.gov/eligibility-groups/family-planning or call the Healthy Connections Member Contact Center at (888) 549-0820 from 8 a.m.-6 p.m. Monday-Friday.

Through this policy change, only the screening codes listed above will be covered for those enrolled in the limited benefit program. Prostate cancer screenings are already a covered service for full benefit Medicaid members. The policy change announced in this bulletin does not affect the services covered for full benefit Medicaid members.

Providers should direct any questions related to this policy update to the SCDHHS Provider Service Center at (888) 289-0709. The Provider Service Center’s hours of operations are 7:30 a.m.-5 p.m. Monday-Thursday and 8:30 a.m.-5 p.m. Friday.

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

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