Update the Psychotherapy Frequency Limits in the Rehabilitative Behavioral Health Services (RBHS) manual in the Drug and Alcohol section

The South Carolina Department of Health and Human Services (SCDHHS), Division of Behavioral Health will update the psychotherapy frequency limits in the Drug Alcohol and Other Drug Abuse Services (DAODAS) section of the Rehabilitative Behavioral Health Services (RBHS) manual as of December 1, 2014. The psychotherapy frequency limits in the DAODAS section will be the same as the rest of the manual. The changes will be reflected in section two and four of the manual. The change will only affect the fee for service claims.

If a Healthy Connections Medicaid member is enrolled with one of the state’s contracted MCOs, DAODAS must receive prior approval and claim reimbursement directly from the member’s MCO for services covered under the managed care service package. For a complete list of managed care covered services, please refer to the managed care policy and procedure manual at https://msp.scdhhs.gov/managedcare/site-page/mco-contract-pp .

See the chart below for the new frequency limits for DAODAS.

Procedure Code Description Procedure Code New Frequency Limits
Individual Psychotherapy (IT) 90832 Encounter - 30 minutes 1 per date of service IT can be rendered in a variety of combinations - 6 sessions per month
Individual Psychotherapy (IT) 90834 Encounter – up to 60 minutes 1 per date of service IT can be rendered in a variety of combinations - 6 sessions per month
Individual Psychotherapy (IT) 90837 Encounter – 60 minutes or more (e.g. 75 or 90 minutes) 1 per date of service IT can be rendered in a variety of combinations - 6 sessions per month
Individual Psychotherapy (IT) When providing Medical Evaluation and Management 90833 With the add on code 99203 or 99213 Encounter - 30 minutes 1 per date of service
Individual Psychotherapy (IT) When providing Medical Evaluation and Management 90836 With the add on code 99203 or 99213 Encounter - 45 minutes 1 per date of service
Family Psychotherapy (without Patient present) 90846 Encounter - 60 minutes 1 per date of service 4 sessions per month
Family Psychotherapy (with Patient present) 90847 Encounter - 60 minutes 1 per date of service 4 sessions per month
Multiple Family Group Psychotherapy 90849 Encounter - 60 minutes 1 per date of service 8 sessions per month
Group Psychotherapy 90853 Encounter - 60 minutes 1 per date of service 8 sessions per month

 

For a complete copy of the policy changes, please refer to the most current version of the RBHS policy manual located on the SCDHHS website at www.scdhhs.gov .

If you should have any questions regarding program policy, please contact the Division of Behavioral Health at (803) 898-2565. Please refer any questions or concerns regarding claims to the SCDHHS Provider Service Center at 1-(888)-289-0709. Thank you for your continued support in the South Carolina Healthy Connections Medicaid program.

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