Autism Spectrum Disorder Prior Authorizations for 0359T

PROVIDER ALERT

The South Carolina Department of Health and Human Services (SCDHHS) seeks to clarify the authorized services outlined in the updated prior authorization letters that were sent to parents/guardians/caregivers for new autism spectrum disorder (ASD) state plan services in early July. The behavior assessment code of 0359T was not included in the authorization letters.

For fee-for-service beneficiaries, SCDHHS will reimburse providers for up to 16 units annually of Behavior Identification Assessment, 0359T, based on medical necessity. The updated prior authorization letter will serve as this authorization.

For members in a managed care organization (MCO) providers should contact the member's MCO for information regarding prior authorization of 0359T.

SCDHHS encourages providers to visit the ASD website, https://msp.scdhhs.gov/autism/, for additional information concerning Medicaid ASD services.

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

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