Other Medical Professionals

Effective with dates of service on or after July 1, 2017, the South Carolina Department of Health and Human Services (SCDHHS) will no longer limit the number of prescriptions available to Medicaid beneficiaries.

If you have any questions regarding this policy, please contact the Provider Service Center at (888) 289-0709.

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

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 for dates of service on or after July 1, 2017, and as required by 1902(a) (25) of the Social Security Act, the South Carolina Department of Health and Human Services (SCDHHS) will implement cost avoidance rules for the procedure codes reflected below. Service providers will be required to file claims to any liable third-party insurer before submitting a claim to SCDHHS for payment.

Effective with dates of service on or after July 1, 2017, the South Carolina Department of Health and Human Services (SCDHHS) is enhancing tobacco cessation coverage for full-benefit Medicaid beneficiaries to align with recommendations from the Centers for Disease Control and Prevention (CDC) and the American Lung Association (ALA). This update applies to both the fee-for-service and managed care Medicaid benefits.

The following medications will be available without prior authorization or co-payment when prescribed by a Medicaid provider:

The Children's Health Access in Community Environments (CHANCE) waiver manual will be withdrawn from the South Carolina Department of Health and Human Services (SCDHHS) website effective June 1, 2017.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.

Individual Psychotherapy Frequencies

Effective with dates of service on or after Jan. 1, 2017, the South Carolina Department of Health and Human Services (SCDHHS) will limit the billable encounters of individual psychotherapy to six per month, unless otherwise prior approved by SCDHHS. Six sessions of individual psychotherapy will be billable each month, in any combination of the following codes: 90832, 90834 and 90837.