Effective for dates of service on or after October 15, 2013, the South Carolina Department of Health and Human Services (SCDHHS) will increase the rate for Synagis® to the current Average Wholesale Price (AWP) minus 18%. The new rate for the 100mg vial will be $2,429.18.  The 50mg vial will be reimbursed at $1,286.44.

SCDHHS will continue to cover Synagis® in accordance with the most recent edition of the American Academy of Pediatrics (AAP) guidelines. The AAP guidelines are available at . Prior approval by the SCDHHS Medical Director is required for any request to administer Synagis® outside of the AAP guidelines.

This bulletin applies to services provided to beneficiaries who are enrolled in fee-for-service Medicaid or a Medical Home Network (MHN).  Questions regarding specific authorization and coverage of this service by one of the Medicaid Managed Care Organizations (MCOs) should be directed to the managed care plan.  Claims for participants enrolled in either a Medical Home Network or the fee-for-service program should be billed directly to Medicaid.  If you have any questions regarding this policy, please contact 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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