Rate Increases for Certain Incontinence Supplies and DAODAS and ASD Services

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Effective Jan. 1, 2022, the South Carolina Department of Health and Human Services (SCDHHS) will increase the reimbursement rates for the services and supplies mentioned below. These rate increases apply to the Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes included in this bulletin.

Incontinence Supplies

SCDHHS will increase the reimbursement rates for incontinence supplies billed using the HCPCS codes listed below by 10%.

Code Description
A4554 Disposable Underpads, All Sizes
T4521 Adult Size, Brief/Diaper - S
T4522 Adult Size, Brief/Diaper - M
T4523 Adult Size, Brief/Diaper - L
T4524 Adult Size, Brief/Diaper - XL
T4525 Adult Size, Protective Underwear/Pull On - S
T4526 Adult Size, Protective Underwear/Pull On - M
T4527 Adult Size, Protective Underwear/Pull On - L
T4528 Adult Size, Protective Underwear/Pull On - XL
T4529 Pediatric Size, Brief/Diaper - S/M
T4530 Pediatric Size, Brief/Diaper - L
T4531 Pediatric Size, Protective Underwear/Pull On - S/M
T4532 Pediatric Size, Protective Underwear/Pull On - L
T4533 Youth Size, Brief/Diaper
T4534 Youth Size, Protective Underwear/Pull On
T4535 Disposable Liner/Shield/Guard/Pad/Undergarment
T4543 Adult Size, Brief/Diaper, Bariatric, XXL
T5999 Supply, Not Otherwise Specified

These changes will be reflected in the Durable Medical Equipment (DME) and the Community Long Term Care (CLTC) fee schedules available on SCDHHS’ website by Jan. 1, 2022.

Department of Alcohol and Other Drug Abuse Services (DAODAS) Services

SCDHHS will increase the reimbursement rates for addiction services billed using the HCPCS codes listed below by 15%.

Code Description
H0001 (with modifiers HO, HN, TS, UC, TD andU2) Alcohol & Drug Assessment
H0004 (with modifier GT) Individual Alcohol/Drug Substance Abuse Counseling
H0011 Alcohol/Drug Services Detox Residential
H0015 Alcohol/Drug Services Intensive OP Treatment Level II.i (hourly)

SCDHHS will also update the reimbursement rates as depicted below for DAODAS peer support services billed using the following HCPCS code:

Code Description New Rate
H0038 Individual $10.74
H0038 (with modifier HQ) Group $1.79

These changes will be reflected in the DAODAS fee schedule available on SCDHHS’ website by Jan. 1, 2022.

Autism Spectrum Disorder (ASD) Services

SCDHHS will update the reimbursement rates as depicted below for ASD services billed using the following CPT codes:

Code Description New Rate
97153 Treatment - RBT $45/hour
97155 Treatment - BCBA/BCaBA $85/hour
97156 Family Training $85/hour

These changes will be reflected in the ASD fee schedule available on SCDHHS’ website by Jan. 1, 2022.

Providers with questions regarding this bulletin should contact 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.

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