Physicians

Physicians

Revised Family Planning Examination/Visits

Effective immediately, the South Carolina Department of Health and Human Services (SCDHHS) no longer requires a physical examination during an initial Family Planning visit in order to prescribe hormonal contraception. This applies to all Medicaid beneficiaries who receive Family Planning services under fee for service and under Check-up. The services that must take place during patient visits are outlined in the following table.

 

 

 

Initial Visit

EPSDT Pediatric Screening Tools

The South Carolina Department of Health and Human Services (SCDHHS) is clarifying the use of developmental and behavioral health pediatric screening tools and providing guidance on the utilization of these tools.  Best practice indicates that standardized screenings of this type are recommended to be done during the Early Periodic Screening, Diagnosis, and Treatment (EPSDT) visits or as dictated by clinical need.  This  is in alignment with the American Academy of Pediatrics (AAP) recommendations regarding screening and age appropriate development and mental health of children and adolescen

Coverage of Hydroxyprogesterone Injection

On December 20, 2013, the South Carolina Department of Health and Human Services (SCDHHS) issued Medicaid Bulletin 13-047 regarding hydroxyprogesterone caproate.  On July 3, 2014, the Food and Drug Administration issued updated guidance in regards to hydroxyprogesterone caproate.  In the new guidance, the FDA provided that its March 2011 statement related to hydroxyprogesterone caproate was superseded by its June 2012 statements in which the FDA “recommended using an FDA-approved drug product, such as Makena, instead of a compounded drug except when there is a specific medical need (e.g.

2015 Medicare Deductible, Coinsurance and Medicaid Blood Deductible Rates for Dual-Eligible (Medicaid and Medicare) Members

The South Carolina Department of Health and Human Services (SCDHHS) has updated its reimbursement calculations for Medicare Deductible, Coinsurance and Blood Deductibles to reflect the new 2015 Medicare Rates for Dual-Eligible (Medicaid and Medicare) members.

South Carolina Medicaid Preferred Drug List

The following revisions to the Preferred Drug List (PDL) are effective with dates of service on or after August 1, 2014. 

ANTIHISTAMINES, MINIMALLY SEDATING

Pulse Oximetry Policy

Effective on or after July 1, 2014, the South Carolina Department of Health and Human Services (SCDHHS) will update its policy to recognize the South Carolina Department of Health and Environmental Control (DHEC) Pulse Oximetry Screening test on newborns to detect congenital heart defects.  Pulse oximetry is a noninvasive test that estimates the percentage of hemoglobin in blood that is saturated with oxygen.   

Inpatient Psychiatric Coverage for beneficiaries 65 or older

Effective for services provided on or after July 1, 2014, the South Carolina Department of Health and Human Services (SCDHHS) will allow for coverage of inpatient psychiatric care for beneficiaries of Medicare and Medicaid who are 65 or older.

Screening, Brief Intervention and Referral to Treatment (SBIRT)

 

Effective with dates of service on or after July 1, 2014, the following codes and billing procedures must be utilized in order to receive payment for the Screening, Brief Intervention and Referral to Treatment (SBIRT) services.

Psychiatric and Psychotherapy Services section of the Physicians, Laboratories, and Other Medical Professionals Manual

Effective July 1, 2014, the South Carolina Department of Health and Human Services (SCDHHS) has reinstated the Psychiatric and Psychotherapy Services section of the Physicians, Laboratories, and Other Medical Professionals Manual.  This section applies to all physicians, psychiatrists, and psychiatric nurse practitioners providing psychiatric services, as well as allied professionals who may provide psychotherapy services under the supervision of these professionals.

Self-Administered Oxygen-Hospital Discharges

Effective June 1, 2014, South Carolina Department Health and Human Services will amend the non-emergency transportation policy for self- administered oxygen dependent beneficiaries discharged from inpatient hospitals or emergency rooms.  This policy change affects Hospitals, Physicians, Ambulance and Durable Medical Equipment (DME) providers.  This policy change will also be posted in the Hospital, Physicians Laboratories and Medical Professional, Ambulance and Durable Medical Equipment manuals located on the SCDHHS website: www.scdhhs.gov.  

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