Reminder About Enhanced Rate for Evaluation Services for Children in Foster Care

PROVIDER ALERT

The South Carolina Department of Health and Human Services (SCDHHS) is reminding providers about the enhanced reimbursement rate for initial evaluation and management encounters with children when they enter foster care. This enhanced reimbursement rate has been in effect since July 1, 2020, to improve timely access to health care services for children who are enrolled in foster care with the goal of ensuring every child receives a comprehensive health assessment within 30 days of entering the foster care program.

The enhanced reimbursement rate is offered for prolonged evaluation and management services before or after directed patient care when initiating a patient-provider relationship with a child in the foster care program. This enhanced reimbursement rate may be billed for the initial visit upon a child’s entry into the foster care program regardless of their service history.

Claims for this service should be billed with Current Procedural Terminology (CPT) code 99358 (“Prolonged evaluation and management service before and/or after direct patient care”) with a modifier of “UA,” which is being defined as “initial visit with patient in foster care.” This code should be submitted along with the appropriate evaluation and management or well-visit code for the direct patient care component.

Providers with questions about the enhanced rate for prolonged evaluation and management services for children enrolled in foster care should contact the Provider Service Center at (888) 289-0709. The Provider Service Center’s hours of operations are 7:30 a.m.-5 p.m. Monday-Thursday and 8:30 a.m.-5 p.m. Friday.

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

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