Autism Spectrum Disorder State Plan Procedure Codes

PROVIDER ALERT

Effective May 1, 2019, the South Carolina Department of Health and Human Services (SCDHHS) will transition from the 2014 Category III Current Procedural Terminology (CPT) codes for adaptive behavior services to the 2019 Category I CPT codes. The 2019 Category I CPT codes are: 

• 97151 – Behavior identification assessment, each 15 minutes

• 97153 – Adaptive behavior treatment by protocol, each 15 minutes

• 97155 – Adaptive behavior treatment with protocol modification, each 15 minutes

• 97156 – Family adaptive behavior treatment guidance, each 15 minutes

Prior authorization (PA) requests submitted to KEPRO before May 1, 2019, must utilize the 2014 Category III CPT codes. Beginning May 1, PA requests must utilize the 2019 Category I CPT codes. For care delivered on or after May 1, providers may continue to bill pursuant to existing authorizations until they expire or providers can submit requests to replace existing authorizations using the 2019 Category I CPT codes.

South Carolina Medicaid managed care organizations (MCOs) will also accept authorization requests and claims using the 2019 Category I CPT codes beginning May 1, 2019. 

Please refer any questions or concerns regarding this alert to the SCDHHS Office of Behavioral Health at (803) 898-2565.

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

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