The Centers for Medicare and Medicaid Services (CMS) has revised the procedure codes for billing psychological testing and evaluation. The South Carolina Department of Health and Human Services (SCDHHS) transitioned to the use of these codes effective July 1, 2019. The following codes were impacted:
Current Procedural Terminology (CPT) code 96101 (psychological testing with interpretation and report by psychologist or physician; per hour) was replaced by the following:
The South Carolina Department of Health and Human Services will be amending its autism spectrum disorder (ASD) manual to include additional providers that will be allowed to complete the comprehensive psychological assessment/testing report to determine if Medicaid beneficiaries meet medical necessity criteria for ASD services.
Effective for dates of service on or after Jan. 1, 2018, and pursuant to South Carolina Budget Proviso 117.135, Section A, the South Carolina Department of Health and Human Services (SCDHHS) will accept Act 301 Behavioral Health Centers (301 Centers) as approved referring sites for Medication Assisted Treatment (MAT) services rendered via telemedicine consultation.
Effective with dates of service on or after July 1, 2017, the South Carolina Department of Health and Human Services (SCDHHS) will include psychiatric residential treatment facility (PRTF) services and providers in the coordinated care benefit provided by SCDHHS-contracted managed care organizations (MCOs). MCO members will access PRTF services through the MCO they have chosen or to which they have been assigned. Individuals not choosing or not mandatorily assigned to an MCO will continue to access PRTF services through the SCDHHS Medicaid fee-for-service (FFS) benefit.
Effective with dates of service on or after July 1, 2017, the South Carolina Department of Health and Human Services (SCDHHS) will allow therapeutic child care (TCC) providers to fulfill the requirement of parallel work with the primary caregiver by rendering family psychotherapy twice per month in conjunction with the TCC service. Family psychotherapy services provided to meet this requirement must be rendered within the stated frequency limits as outlined in the Rehabilitative Behavioral Health Services manual.
The Children's Health Access in Community Environments (CHANCE) waiver manual will be withdrawn from the South Carolina Department of Health and Human Services (SCDHHS) website effective June 1, 2017. The CHANCE waiver was a Psychiatric Residential Treatment Facilities (PRTF) community alternatives demonstration waiver. This waiver was discontinued in September 2014.
Effective Jan. 1, 2017, the South Carolina Department of Health and Human Services (SCDHHS) will include Advanced Practice Registered Nurses (APRNs) as ordering providers of Medical Management Only (MMO) for providers under the Community Mental Health provider manual.
Should you have any questions regarding this bulletin, please contact the SCDHHS Division of Behavioral Health at (803) 898-2565.
Thank you for your continued support of the South Carolina Healthy Connections Medicaid program.
The South Carolina Department of Health and Human Services (SCDHHS) is revising the Rehabilitative Behavioral Health Services (RBHS) Policy Manual. Changes will be effective with dates of service on or after July 1, 2016. This bulletin provides notice and an overview of revisions effective July 1, 2016; it is not intended to reflect all revisions in the manual. The RBHS manual may be subject to further change.
The South Carolina Department of Health and Human Services (SCDHHS) is beginning 2016 Provider Revalidation. Durable Medical Equipment and Rehabilitative Behavioral Health Services providers who enrolled as a Healthy Connections Medicaid provider between Dec. 1, 2012-Dec. 31, 2013, are scheduled for revalidation in 2016.