EPSDT Screening Clinics

EPSDT Screening Clinics

Adding Developmental Pediatricians to the Comprehensive Diagnostic Assessment

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.

Pediatric Screening (CPT) 96127

Effective Nov. 1, 2016, the South Carolina Department of Health and Human Services (SCDHHS) will limit payment for Current Procedural Terminology (CPT) code 96127 to a maximum of two units per date of service. This is consistent with the National Correct Coding Initiative (NCCI) Medically Unlikely Edit (MUE) limit for this service. This bulletin supersedes previous SCDHHS guidance, provided March 31, 2015, indicating that a maximum of four units are payable per date of service for CPT code 96127.

Autism Spectrum Disorder Services Interim Process

The South Carolina Department of Health and Human Services (SCDHHS) has established an interim process by which Healthy Connections Medicaid members can access Autism Spectrum Disorder (ASD) services that are identified as medically necessary based on an Early and Periodic Screening Diagnosis and Treatment (EPSDT) encounter.

Members 0-21 years old are eligible to submit requests for ASD services, including members currently on the Pervasive Developmental Disorder (PDD) Waiver waiting list as well as those whose PDD Waiver services have expired.

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

Behavioral Health Screening Tools Clarification

 

The South Carolina Department of Health and Human Services (SCDHHS) expanded the availability of behavioral health pediatric screening tools in a Medicaid Bulletin, dated May 17, 2013.

Enhanced Physician Payment Reimbursement

 

The South Carolina Department of Health and Human Services (SCDHHS) recently received final CMS approval for its proposed payment methodology for the Affordable Care Act (ACA) Primary Care Physician rate increase for both the Fee for Service (FFS) and Managed Care Organizations (MCOs).  SCDHHS continues its work on this project to ensure that it is implemented accurately, quickly and within the CMS mandates for these enhanced payments.  

Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Periodicity Schedule

For a copy of the updated periodicity schedule and the services to be performed with each visit, please refer to the Physicians, Laboratories, and Other Medical Professionals manual located on our website at www.scdhhs.gov.

This bulletin affects the policy for fee-for-service and the Medical Homes Network (MHN).  Please contact the appropriate Managed Care Organization (MCO) for their coverage policy. 

Tobacco Cessation for Pregnant Women

Effective with dates of service on or after February 1, 2012, the South Carolina Department of Health and Human Services (SCDHHS) will cover Tobacco Cessation treatment for all pregnant women in accordance with Section 4107 of the Affordable Care Act, which amended Section 1905 (bb)(2) of the Social Security Act. For the complete policy and billing instructions, please review the Physician, Laboratories and Other Medical Professionals manual located on the SCDHHS website at www.scdhhs.gov.

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