Primary Care Physician Fee Schedule Enhancement

PROVIDER ALERT

The South Carolina Department of Health and Human Services (SCDHHS) recently published bulletins dated on Nov. 26, 2014, and Dec. 31, 2014, regarding fee schedule enhancements for qualifying primary care physician specialties. Previous bulletins only listed the fee schedule for services performed in a non-facility setting by qualifying providers. The attached Enhanced Qualifying Primary Care fee schedule reflects payment rates for both the facility and non-facility settings and is available on the SCDHHS website at: https://www.scdhhs.gov/resource/fee-schedules under the Physicians header.

Please refer any questions or concerns regarding this matter to the Provider Service Center at (888) 289-0709.

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

SCDHHS 2015 Qualifying Provider Fee Schedule: Primary Care Physicians
Procedure Code Qualifying Provider Fee Schedule-Not In Facility Qualifying Provider Fee Schedule- In Facility Procedure Code Qualifying Provider Fee Schedule-Not In Facility Qualifying Provider Fee Schedule- In Facility Procedure Code Qualifying Provider Fee Schedule-Not In Facility Qualifying Provider Fee Schedule- In Facility
90460 $20.16 $20.16 99285 $168.49 $168.49 99394 $111.18 $84.90
90461 $11.88 $11.88 99291 $262.97 $216.97 99395 $113.64 $87.36
99201 $40.87 $25.43 99292 $118.45 $108.60 99396 $121.25 $94.96
99202 $70.59 $48.57 99304 $89.65 $89.65 99397 $130.34 $100.11
99203 $102.41 $73.83 99305 $127.76 $127.76 99401 $34.74 $23.89
99204 $157.93 $126.39 99306 $162.25 $162.25 99402 $59.91 $49.39
99205 $197.34 $163.50 99307 $43.09 $43.09 99403 $83.80 $73.29
99211 $18.87 $9.01 99308 $66.40 $66.40 99404 $107.94 $97.42
99212 $41.20 $24.45 99309 $87.59 $87.59 99460 $92.39 $92.39
99213 $69.40 $49.69 99310 $130.37 $130.37 99464 $69.46 $69.46
99214 $102.66 $76.37 99315 $70.62 $70.62 99465 $143.21 $143.21
99215 $137.81 $107.58 99316 $101.64 $101.64 99466 $247.50 $247.50
99217 $69.96 $69.96 99318 $92.82 $92.82 99467 $119.69 $119.69
99218 $96.30 $96.34 99324 $53.76 $53.76 99468 $903.46 $903.46
99219 $131.51 $131.51 99325 $78.41 $78.41 99469 $385.80 $385.80
99220 $179.85 $179.85 99326 $135.33 $135.33 99471 $829.11 $829.11
99221 $98.01 $98.01 99327 $180.40 $180.40 99472 $391.08 $391.08
99222 $133.31 $133.31 99328 $209.48 $209.48 99475 $558.41 $558.41
99223 $196.71 $196.71 99334 $58.55 $58.55 99476 $337.39 $337.39
99224 $38.60 $38.60 99335 $91.86 $91.86 99477 $338.36 $338.36
99225 $70.42 $70.42 99336 $129.74 $129.74 99478 $133.86 $133.86
99226 $101.53 $101.53 99337 $186.92 $186.92 99479 $121.44 $121.44
99231 $38.05 $38.05 99341 $53.43 $53.43 99480 $116.85 $116.85
99232 $69.99 $69.99 99342 $77.32 $77.32      
99233 $100.87 $100.87 99343 $126.58 $126.58      
99234 $130.53 $130.53 99344 $176.53 $176.53      
99235 $163.92 $163.92 99345 $212.88 $212.88      
99236 $211.61 $211.61 99347 $53.73 $53.73      
99238 $70.07 $70.07 99348 $81.49 $81.49      
99239 $103.51 $103.51 99349 $123.40 $123.40      
99241 $46.33 $32.53 99350 $171.94 $171.94      
99242 $87.37 $67.98 99354 $96.52 $90.28      
99243 $119.57 $94.92 99356 $89.10 $89.10      
99244 $178.00 $151.06 99360 $60.18 $60.18      
99245 $217.78 $187.55 99381 $105.61 $75.39      
99251 $48.14 $48.14 99382 $110.31 $80.08      
99252 $73.64 $73.64 99383 $115.13 $84.90      
99253 $112.59 $112.59 99384 $130.34 $100.11      
99254 $162.86 $162.86 99385 $126.46 $96.24      
99255 $196.71 $196.71 99386 $146.30 $116.73      
99281 $20.51 $20.51 99387 $158.79 $125.28      
99282 $40.20 $40.20 99391 $95.12 $68.83      
99283 $60.09 $60.09 99392 $101.67 $75.39      
99284 $114.43 $114.43 99393 $101.34 $75.39      
 
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