Last updated 08/18/2023
Email, Phone & Fax
When audio/visual telehealth is not available, SCDHHS will continue to reimburse providers for one year beyond the end date of the current federal PHE for the audio-only CPT codes included in the source referenced below (see bulletin).
Reimbursement for the CPT codes included will continue to be limited to encounters with established patients as described in Medicaid bulletin 20-004 when rendered by a physician, nurse practitioner, physician assistant or licensed independent practitioner (LIP). Additional services that can be provided via audio-only during this extended time period include certain services for BabyNet-enrolled Children.
SOURCE: SC Dept. of Health and Human Services. Medicaid Bulletin 22-005. (May 2023). (Accessed Aug. 2023).
Services that are eligible for telehealth reimbursement include consultation, office visits, individual psychotherapy, pharmacologic management, and psychiatric diagnostic interview examinations and testing, delivered via a telecommunication system, and audio-only (telephonic) care (available for established patients only).
While SC Medicaid includes the above mention of audio-only coverage, and certain telephonic codes are also noted as covered in the Telehealth Fee Schedule, the manual also states that the following interactions do not constitute reimbursable telehealth or telepsychiatry services and will not be reimbursed:
- Telephone conversations
- Email messages
- Video cell phone interactions
- Facsimile transmissions
- Services provided by allied health professionals
SOURCE: SC Health and Human Svcs. Dept. Physicians Provider Manual, p. 33, 161 (Jul. 2023). (Accessed Aug. 2023).
FQHCs/RHCs Behavioral Health Services
Family Therapy: Billing for telephone calls is not allowed.
SOURCE: SC Health and Human Svcs. Dept. Federally Qualified Health Center Behavioral Health Services Provider Manual, p. 26, (Feb. 2023) & Rural Health Clinic Behavioral Health Services Provider Manual, p. 25, (Jan. 2020), (Accessed Aug. 2023).
Despite the above exclusion, according to a recent Medicaid bulletin, telehealth services rendered through an FQHC or RHC for certain audio-only CPT codes will be reimbursed.
SOURCE: SC Dept. of Health and Human Services. Medicaid Bulletin 22-005. (May 2023). (Accessed Aug. 2023).
Medicaid Targeted Case Management
Electronic visual encounters (e.g., Skype, teleconferencing or other media) with the beneficiary are not considered a face-to-face contact and will be reimbursed at the T1016 MTCM encounter rate.
- A telephone contact is in lieu of a face-to-face contact when environmental considerations preclude a face-to-face encounter, for the purpose of rendering one or more MTCM components. Documentation must include details precluding a face-to-face encounter.
- A relevant email contact via secured transmittal, on behalf of the beneficiary for the purpose of rendering one or more MTCM components.
For Medicaid purposes, a face-to-face contact is preferable with phone and/or email contact being acceptable if necessary.
SOURCE: SC Health and Human Svcs. Dept., Medicaid Targeted Case Management Provider Guide, p. 21 (Apr. 2021). (Accessed Aug. 2023).
Behavioral Health Services
Telehealth and audio-only modalities are available for select behavioral health services including telephonic assessments, crisis intervention, individual and family psychotherapy, psychiatric diagnostic assessments, nursing services, service plan development, and medication management. These services are available for providers enrolled under CHMC, RBHS, or LIP categories and include physicians, nurse practitioners, and physician assistants, Licensed Psychologists (and postdoctoral pending licensure), Licensed Professional Counselors (and LPC-associate), Licensed Independent Social Workers, Licensed Marriage and Family Therapists (and LMFT-associate), and Licensed Psycho-Educational Specialists.
Crisis Management: The purpose of this face-to-face or telephonic short-term service is to assist a beneficiary who is experiencing urgent or emergent marked deterioration of functioning related to a specific precipitant
in restoring his or her level of functioning.
Face-to-face inventions require immediate response by a clinical professional and include telephonic interventions that are provided either to the beneficiary or on behalf of the beneficiary to collect an adequate amount of information to provide appropriate and safe services, stabilize the beneficiary, and prevent a negative outcome.
SOURCE: SC Health and Human Svcs. Dept. Rehabilitative Behavioral Health Services Provider Manual, p. 59-60, 89. (Jul. 2023); SC Health and Human Svcs. Dept. Licensed Independent Practitioner’s Rehabilitative Provider Manual, p. 13, 14, 17, 19, 20 & 21. (May 2023). (Accessed Aug. 2023).
Some services rendered by LIPs may be provided via telehealth or audio-only modalities with the use of a GT modifier. These services include audio-only assessments for established patients, and psychotherapy and psychiatric evaluations for new and established patients.
Psychological Test and Evaluation – When necessary/appropriate, consultation shall only include telephone or face-to-face contact by a Psychologist/LPES to the family, school, or another health care provider to interpret or explain the results of psychological testing and/or evaluations related to the care and treatment of the beneficiary. The Psychologist/LPES must document the recommended course of action.
Service Plan Development (SPD) is a face-to-face or telephonic interaction between the beneficiary and a qualified clinical professional or a team of professionals.
Telephone contact related to office procedures or appointment times are not covered.
Last updated 08/18/2023
Live Video
POLICY
South Carolina Medicaid will reimburse for live video and covers telemedicine when the service is medically necessary and under the following circumstances:
- The medical care is individualized, specific, and consistent with symptoms or confirmed diagnosis of the illness or injury under treatment, and not in excess of the beneficiary’s need; and
- The medical care can be safely furnished, and no equally effective and more conservative or less costly treatment is available statewide.
If there are technological difficulties in performing a medical assessment or problems in a beneficiaries’ understanding of telemedicine, face-to-face care must be provided instead.
Interactive audio and video telecommunication must be used; permitting encrypted communication between the distant site physician or practitioner and the Medicaid beneficiary. The telecommunication service must be secure and adequate to protect the confidentiality and integrity of the telemedicine information transmitted.
The telemedicine equipment and transmission speed and image resolution must be technically sufficient to support the service billed. Staff involved in the telemedicine visit must be trained in the use of the telemedicine equipment and competent in its operation.
Reimbursement to the health professional delivering the medical service is the same as the current fee schedule amount for the service provided. See appropriate professional manuals for CPT codes. Codes must be billed along with the telemedicine GT modifier.
SOURCE: SC Health and Human Svcs. Dept. Physicians Provider Manual, p. 31, 33, 34, 217 (Jul. 2023). (Accessed Aug. 2023).
To qualify for reimbursement, interactive audio and video equipment that permits two-way real-time or near real-time communication with the client, consultant, interpreter, and referring clinician.
Additional requirements include:
- Reimbursement requires the “real-time” presence of a client.
- Reimbursement is available for psychiatric diagnosis assessment with Medicaid and medical evaluation and management codes.
- GT modifier must be used when billing the for telepsychiatric services.
- All equipment must operate at a minimum communication transfer rate of 384 kbps.
- Telepsychiatry reimbursement is not available for the following MH services; injectable, NS, CI Individual Family, Group and Multiple FP and Psychological Testing which require “hands on” encounters, Mental Health Assessment by Non-Physician and SPD.
SOURCE: SC Health and Human Svcs. Dept. Community Mental Health Services Provider Manual, p. 30. (Jan. 2023). (Accessed Aug. 2023).
ELIGIBLE SERVICES/SPECIALTIES
Telehealth services are not an expansion of covered services, but an option for the delivery of certain covered services. Telehealth includes consultation, diagnostic and treatment services.
Services that are eligible for reimbursement include consultation, office visits, individual psychotherapy, pharmacologic management, and psychiatric diagnostic interview examinations and testing, delivered via a telecommunication system.
Office and OP visits that are conducted via telehealth are counted towards the applicable benefit limits for these services.
Well-care visits conducted via telehealth must be billed with the appropriate EPSDT code and a GT modifier.
Services provided by allied health professionals are not covered.
A list of Medicaid telehealth services can be found in the Procedure Codes section of the Manual and Telehealth Fee Schedule.
SOURCE: SC Health and Human Svcs. Dept. Physicians Provider Manual, p. 31, 33, 161, 227 (Jul. 2023). (Accessed Aug. 2023).
Local education manual refers providers to the physician Services Provider Manual for information regarding coverage and billing for telemedicine.
SOURCE: SC Health and Human Svcs. Dept. Local Education Provider Manual, p. 22. (Jan. 2023). (Accessed Aug. 2023).
Medicaid Targeted Case Management
Electronic visual encounters (e.g., Skype, teleconferencing or other media) with the beneficiary are not considered a face-to-face contact and will be reimbursed at the T1016 MTCM encounter rate.
SOURCE: SC Health and Human Svcs. Dept., Medicaid Targeted Case Management Provider Guide, p. 21 (Apr. 2021). (Accessed Aug. 2023).
Telepsychiatry
Psychiatric Diagnostic assessment with medical services to assess or monitor the client’s psychiatric and/or physiological status may be provided via live video telepsychiatry. See manual for specific requirements.
SOURCE: SC Health and Human Svcs. Dept. Community Mental Health Services Provider Manual, p. 30 (Jan. 2023). (Accessed Aug. 2023).
Applied Behavior Analysis
SCDHHS will continue to reimburse providers for the ABA services described in the bulletin referenced in the source below when rendered through telehealth for one year beyond the end date of the current federal PHE. These flexibilities will be extended for remote supervision of registered behavior technicians (RBTs) who provide service in a face-to-face setting and consultation of parent-directed activities via telehealth for the CPT codes listed as described in Medicaid bulletin 20-011. These flexibilities will be extended for encounters that include both audio and visual components.
SOURCE: SC Dept. of Health and Human Services. Medicaid Bulletin 22-005. (May 2023). (Accessed Aug. 2023).
Authorized synchronous audio/visual supervision of RBTs and other therapists is available using telehealth for established patients. Services provided via telehealth are to be reimbursed in lieu of, not in addition to, those provided face-to-face and reimbursed in a manner consistent with the authorities and limitations detailed in the State Plan and this provider manual. Use of a GT modifier will be required for any telehealth visits in addition to any other modifier(s) required for the service. The GT modifier will be listed in the secondary modifier position, with any other required modifier listed in the primary modifier position.
If in-person interaction with an RBT or other therapist is not feasible, services below may be provided via telehealth for consultation by providers authorized to practice independently, when provided through a parent or family member.
SOURCE: SC Health and Human Svcs. Autism Spectrum Disorder Provider Manual, p. 18 (Jul. 2023). (Accessed Aug. 2023).
Behavioral Health
Prior to the COVID-19 PHE, SCDHHS’ Medicaid program covered a broad array of behavioral health services that were eligible for reimbursement when delivered using audio and visual interactions to ensure access to services in a variety of settings. SCDHHS will continue to augment the state’s existing behavioral health telehealth benefit and extend the flexibilities included below for one year beyond the end date of the current federal PHE. Services described within the bulletin referenced in the source below are eligible for reimbursement when delivered by LIPs and associate-level licensed practitioners as described in Medicaid bulletins 20-009, 20-014 and 20-016. Services rendered through an FQHC or RHC for the CPT codes listed will be reimbursed. Services described will also be continued for this period for mental health professional master’s level personnel employed by other state agencies.
Developmental Evaluation Center (DEC) Screenings
SCDHHS will continue to reimburse DECs for services rendered through telehealth for one year beyond the end date of the current federal PHE. These flexibilities will be extended for encounters that include both audio and visual components. As specified in the SCDHHS memo issued April 16, 2020, services rendered by a physician, NP, PA or psychologist for the below Healthcare Common Procedure Coding System (HCPCS) codes will be reimbursed subject to the same duration requirements and service limits as services delivered face-to-face.
Addiction and Recovery-related Services
SCDHHS will continue to reimburse for management of medication-assisted treatment (MAT) services and services rendered by Act 301 local alcohol and drug abuse authorities (local authorities) delivered through telehealth for one year beyond the end date of the current federal PHE. These continued flexibilities apply to the procedure codes listed below for the services and provider types described in the memo SCDHHS issued April 17, 2020, and Medicaid bulletin 20-017 with the exception of audio-only telephonic coverage of MAT services, which will sunset with the end of the current federal PHE.
Telehealth Services for BabyNet-enrolled Children
SCDHHS will continue to reimburse providers for early intervention services and development of individualized family service plans (IFSPs) rendered through telehealth. These flexibilities will be extended for one year beyond the end date of the current federal PHE. Services for the procedure codes listed below will continue to be reimbursed when rendered as described in Medicaid bulletin 20-010 and the Medicaid alert dated July 9, 2020. Interpretation services as described in Medicaid bulletin 20-010 will also continue for one year beyond the end date of the current federal PHE. Additional billing guidance for these services is available in the memo issued by SCDHHS on April 30, 2020.
In addition to the physical and speech therapy services described above, providers can also continue to be reimbursed for occupational therapy rendered through telehealth for children enrolled in the BabyNet program as described in Medicaid bulletin 20-008.
Child Well-care and Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Visits
SCDHHS will continue to reimburse providers for child well-care and EPSDT visits rendered through telehealth. These continued flexibilities apply to the policy changes described in Medicaid bulletin 20-015 for encounters that include both audio and visual components.
Physical and Speech Therapy Services
SCDHHS will continue to reimburse for physical and speech therapy services that include both audio and visual components for one year beyond the end date of the current federal PHE. These continued flexibilities apply to physical and speech therapy services rendered by the provider types and procedure codes listed below for services described in Medicaid bulletins 20-008 and 20-016, with the exception of services provided as audio-only telephonic services, which will no longer be reimbursable upon expiration of the current federal PHE.
SOURCE: SC Dept. of Health and Human Services. Medicaid Bulletin 22-005. (May 2023). (Accessed Aug. 2023).
Occupational Therapy
Occupational therapy services described in Medicaid bulletins 20-008 and 20-016 will continue to be eligible for reimbursement when delivered via telehealth that includes both audio and visual components for one year beyond the end date of the current federal PHE. Initial evaluations still must be performed in a face-to-face encounter to be eligible for reimbursement.
SOURCE: SC Dept. of Health and Human Services. Medicaid Bulletin Update on Occupational Therapy Telehealth Flexibilities. (Oct. 2022). (Accessed Aug. 2023).
ELIGIBLE PROVIDERS
Providers who meet the Medicaid credentialing requirements and are currently enrolled with the South Carolina Medicaid program are eligible to bill for telehealth and telepsychiatry when the service is within the scope of their practice. The referring provider is the provider who has evaluated the beneficiary, determined the need for a consultation, and has arranged the services of the consulting provider for the purpose of consultation, diagnosis and/or treatment. The consulting provider is the provider who evaluates the beneficiary via telehealth mode of delivery upon the recommendation of the referring provider.
Practitioners at the distant site who may furnish and receive payment of covered telehealth services are:
- Physicians
- NPs
- PAs
- Licensed Independent Practitioners (and associates)
- Physical, occupational, and speech therapists
A licensed physician, NP, PA, licensed psychologist, licensed professional counselor, licensed independent social worker, and licensed marriage and family counselor may provider telepsychiatry services.
A consultant site means the site at which the specialty physician or practitioner providing the medical care is located at the time the service is provided via telehealth. The health professional providing the medical care must be currently and appropriately licensed in South Carolina. FQHC and RHC providers are eligible to serve as consulting site providers for telehealth services.
Consulting site physicians and practitioners submit claims for telehealth or telepsychiatry services using the appropriate CPT code for the professional service along with the telehealth modifier GT, “via interactive audio and video telecommunications system”. By coding and billing the “GT” modifier with a covered telehealth procedure code, the consulting site physician and/or practitioner certifies that the beneficiary was present at originating site when the telehealth service was furnished.
The RHCs and FQHCs would bill an encounter code when operating as the consulting site. Only one encounter code can be billed for a DOS. Both provider types will use the appropriate encounter code for the service along with the “GT” modifier (via interactive audio and video telecommunications system) indicating interactive communication was used.
SOURCE: SC Health and Human Svcs. Dept. Physicians Provider Manual, p. 32-33, 215. (Jul. 2023) (Accessed Aug. 2023).
SCDHHS will continue to reimburse FQHCs and RHCs for services rendered through telehealth. This extension applies to the flexibilities announced in Medicaid bulletin 20-007 and to the services described within the bulletin referenced in the source below.
SOURCE: SC Dept. of Health and Human Services. Medicaid Bulletin 22-005. (May 2023). (Accessed Aug. 2023).
ELIGIBLE SITES
Eligible originating (referring) sites:
- Practitioner offices (physician, NP, CNM, PA or LIP);
- Hospitals (inpatient and outpatient);
- Rural Health Clinics;
- Federally Qualified Health Centers;
- Community Mental Health Centers;
- Public Schools;
- Act 301 Behavioral Health Centers
- Patient home
A referring site (also known as an originating site) is the location of an eligible Medicaid beneficiary at the time the service being furnished via a telecommunication system occurs. Medicaid beneficiaries are eligible for telehealth services only if they are presented from a referring site located in the SCMSA. Referring site presenters may be required to facilitate the delivery of this service. Referring site presenters should be a person knowledgeable in how the equipment works and able to provide clinical support if needed during a session.
A trained health care professional at the referring site is required to present (patient site presenter) the beneficiary to the physician or practitioner at the consulting site and remain available as clinically appropriate (this condition is waived when the referring site is the patient home).
SOURCE: SC Health and Human Svcs. Dept., Physicians Provider Manual, p. 32, 34 (Jul. 2023). (Accessed Aug. 2023).
Local Education Agency Manual refers providers to the Physician Manual Policy.
SOURCE: Local Education Manual, p. 22. (Jan. 2023). (Accessed Aug. 2023).
SCDHHS will waive referring site restrictions that existed prior to the COVID-19 PHE, which will allow providers to be reimbursed for services delivered via telehealth to Healthy Connections Medicaid members regardless of the members’ location as described in Medicaid bulletin 20-005. This flexibility applies to the evaluation and management (E/M) Current Procedural Terminology (CPT) codes listed in the bulletin referenced in the source below for services rendered by a physician, nurse practitioner, or physician assistant. This flexibility will be made permanent for evaluation and management encounters that include both audio and visual components.
SOURCE: SC Dept. of Health and Human Services. Medicaid Bulletin 22-005. (May 2023). (Accessed Aug. 2023).
GEOGRAPHIC LIMITS
A consultant site means the site at which the specialty physician or practitioner providing the medical care is located at the time the service is provided via telehealth. The health professional providing the medical care must be currently and appropriately licensed in South Carolina. FQHC and RHC providers are eligible to serve as consulting site providers for telehealth services.
FACILITY/TRANSMISSION FEE
The referring site is only eligible to receive a facility fee for telehealth services. Claims must be submitted with an appropriate HCPCS code (telehealth originating site facility fee). If a provider from the referring site performs a separately identifiable service for the beneficiary on the same day as telehealth, documentation for both services must be clearly and separately identified in the beneficiary’s medical record, and both services are eligible for full reimbursement.
RHCs and FQHCs are eligible to receive reimbursement for a facility fee for the telehealth services when operating as the referring site. Claims must be submitted with the HCPCS code for telehealth originating site facility fee. When serving as the referring site, the RHCs and FQHCs cannot bill the encounter code if these are the only services being rendered.
Hospital providers are eligible to receive reimbursement for a facility fee for telehealth when operating as the referring site. Claims must be submitted with the appropriate telehealth revenue code. There is no separate reimbursement for telehealth services when performed during an inpatient stay, OP clinic or ER visit, or OP surgery, as these are all-inclusive payments.
