South Carolina

Last updated 08/26/2024

Consent Requirements

Last updated 08/26/2024

Definitions

Telehealth is defined as the provision of healthcare via electronic communications technology between a provider in one location and a patient in another location without loss of quality of care.

Electronic communication means the use of interactive telecommunication equipment that typically includes audio and video equipment permitting two-way, real-time interactive communication between the patient and the provider at the referring site.

Though there are differences in the definitions of telehealth and telemedicine, the two terms are generally used interchangeably, and SCDHHS will reference telehealth in this and other provider manuals addressing the provision of services via electronic communications.

Telehealth includes consultation, diagnostic and treatment services. Telehealth as a service delivery option, in some cases, can provide beneficiaries with increased access to specialists, better continuity of care, and eliminate the hardship of traveling extended distances.

SOURCE: SC Health and Human Svcs. Dept., Physicians Provider Manual, p. 32 (Sept. 2024). (Accessed Aug. 2024).

Last updated 08/26/2024

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.

*On March 21, 2024 SCDHHS issued Medicaid bulletin 24-010 to announce that flexibilities continued for one year after the expiration of the federal PHE are now extended by SCDHHS through Dec. 31, 2024. This extension aligns with a similar policy announced by the Centers for Medicare and Medicaid Services that extended telehealth flexibilities issued during the COVID-19 federal PHE for Medicare providers through Dec. 31, 2024.

SOURCE: SC Dept. of Health and Human Services. Medicaid Bulletin 22-005. (May 2023); SC Dept. of Health and Human Services. Medicaid Bulletin 24-010. (Mar. 2024). (Accessed Aug. 2024).

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 is 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 under evaluation and management services 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. 34, 144-146 (Sept. 2024). (Accessed Aug. 2024).

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. 27, (Sept. 2023) & Rural Health Clinic Behavioral Health Services Provider Manual, p. 30, (Sept. 2020), (Accessed Aug. 2024).

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. 2024).

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. 31 (Jul. 2024). (Accessed Aug. 2024).

Last updated 08/26/2024

Live Video

POLICY

Children and adult beneficiaries are eligible to receive services via telehealth modality under the State Plan benefit (authority).

South Carolina Medicaid 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.
• The medical care can be safely furnished.
• No equally effective, more conservative or less costly treatment is available Statewide

The following conditions apply to all services rendered via telehealth.

• The beneficiary must be present and participating in the telehealth visit. Any exemptions to this condition (such as inter professional consultation services) will be otherwise listed under the exempted service section of the Physician Services Provider Manual respectively).
• The referring provider must provide pertinent medical information and/or records to the consulting provider via a secure transmission.
• 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 telehealth information transmitted.
• The telehealth equipment and transmission speed and image resolution must be technically sufficient to support the service billed. Any staff involved in the telehealth visit must be trained in the use of the telehealth equipment and competent in its operation.
• A trained healthcare professional at the referring site (patient site presenter) is required to present the beneficiary to the provider at the consulting site and remain available as clinically appropriate (this condition is waived when the referring site is the patient home).
• If the beneficiary is a minor (under 18 years old), a parent and/or guardian must present the minor for telehealth service unless otherwise exempted by State or Federal law. The parent and/or guardian need not attend the telehealth session unless attendance is therapeutically appropriate.
• The beneficiary retains the right to withdraw from the telehealth visit at any time.
• All telehealth activities must comply with the requirements of HIPAA: Standards for Privacy of individually identifiable health information and all other applicable State and Federal Laws and regulations.
• The beneficiary has access to all transmitted medical information, except for live interactive video, as there is often no stored data in such encounters.
• The provider at the distant site must obtain prior approval for service when services require prior approval, based on service type or diagnosis.

Reimbursement to the health professional delivering the medical service is the same as the current fee schedule amount for the service provided. 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 the referring site when the telehealth service was furnished. Fee schedules are located on the SCDHHS website at http://www.scdhhs.gov.

SOURCE: SC Health and Human Svcs. Dept. Physicians Provider Manual, p. 32-35, 193. (Sept. 2024). (Accessed Aug. 2024).

To qualify for reimbursement, interactive audio and video equipment that permits two-way real-time or near real-time communication between the beneficiary, 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. 31. (Mar. 2024). (Accessed Aug. 2024).

Rehabilitative Therapy

SCDHHS provides coverage for the delivery of certain rehabilitative therapy services via telehealth from a consultant site to a referring site within the limitations described below:

• The consultant site (distant site) is the physical location where a specialty physician or practitioner providing medical care is located at the time the service is provided via telehealth. The provider performing the medical care must have a valid, active license in South Carolina.
• The referring site (patient site) is the location of a Medicaid beneficiary at the time the service is being furnished.

The following conditions apply to all rehabilitative therapy services rendered via telehealth:

• The beneficiary must be present and participating in the telehealth visit.
• Interactive audio and video telecommunication must allow encrypted communication between the distant site practitioner and the Medicaid beneficiary. The telecommunication system must be secure and adequate to protect the confidentiality and integrity of the telehealth information transmitted.
• The telehealth equipment and transmission speed and image resolution must be technically sufficient to support the service billed. Any staff involved in the telehealth visit must be trained in the use of the telehealth equipment and competent in its operation.
• A trained healthcare professional at the referring site (patient site presenter) is required to present the beneficiary to the practitioner at the consulting site and remain available as clinically appropriate (this condition is waived when the referring site is the beneficiary’s home).
• If the beneficiary is a minor (under 18 years), a parent and/or guardian must present the minor for telehealth service unless otherwise exempted by State or Federal law. The parent and/or guardian need not attend the telehealth session unless attendance is therapeutically appropriate.
• The beneficiary retains the right to withdraw from the telehealth visit at any time.
• All telehealth activities must comply with the requirements of HIPAA: Standards for Privacy of individually identifiable health information and all other applicable State and Federal Laws and regulations.
• The beneficiary has access to all transmitted medical information, except for live interactive video, as there is often no stored data in such encounters.
• The provider at the distant site must obtain prior approval for service when services require prior approval, based on service type or diagnosis.

Rehabilitative therapy services delivered via telehealth are a continuation of the therapy services provided in an office or outpatient setting. Quality of health care must be maintained regardless of the mode of delivery.

See Rehabilitative Therapy manual for procedure codes allowed via telehealth.

SOURCE: SC Health and Human Svcs. Dept. Rehabilitative Therapy and Audiological Services Provider Manual, p. 8-9 (Jul. 2024). (Accessed Aug. 2024).

Federally Qualified Health Center/Rural Health Center Services

Telehealth substitutes for an in-person visit, and generally involves two-way, interactive technology that permits communication between the practitioner and patient. FQHCs/RHCs can provide telehealth to extend care when a patient is in a different location.

SOURCE: SC Health and Human Svcs. Dept. Federally Qualified Health Center Provider Manual, p. 20. (Sept. 2024) & SC Health and Human Svcs. Dept. Rural Health Clinic Provider Manual, p. 19. (Sept. 2024). (Accessed Sept. 2024).

ELIGIBLE SERVICES/SPECIALTIES

Telehealth services are not an expansion of Medicaid-covered services but an option for the delivery of certain covered services. Quality of health care must be maintained regardless of the mode of delivery. 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.

A list of Medicaid telehealth services can be found in the Procedure Codes section of this manual.

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.

SOURCE: SC Health and Human Svcs. Dept. Physicians Provider Manual, p. 32, 34, 145, 204 (Sept. 2024). (Accessed Aug. 2024).

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. 2024).

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 Manual, p. 31 (Jul. 2024). (Accessed Aug. 2024).

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. 20 (Mar. 2024). (Accessed Aug. 2024).

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.

*On March 21, 2024 SCDHHS issued Medicaid bulletin 24-010 to announce that flexibilities continued for one year after the expiration of the federal PHE are now extended by SCDHHS through Dec. 31, 2024. This extension aligns with a similar policy announced by the Centers for Medicare and Medicaid Services that extended telehealth flexibilities issued during the COVID-19 federal PHE for Medicare providers through Dec. 31, 2024.

SOURCE: SC Dept. of Health and Human Services. Medicaid Bulletin 22-005. (May 2023); SC Dept. of Health and Human Services. Medicaid Bulletin 24-010. (Mar. 2024). (Accessed Aug. 2024).

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. 19 (Jul. 2024). (Accessed Aug. 2024).

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.

*On March 21, 2024 SCDHHS issued Medicaid bulletin 24-010 to announce that flexibilities continued for one year after the expiration of the federal PHE are now extended by SCDHHS through Dec. 31, 2024. This extension aligns with a similar policy announced by the Centers for Medicare and Medicaid Services that extended telehealth flexibilities issued during the COVID-19 federal PHE for Medicare providers through Dec. 31, 2024.

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.

*On March 21, 2024 SCDHHS issued Medicaid bulletin 24-010 to announce that flexibilities continued for one year after the expiration of the federal PHE are now extended by SCDHHS through Dec. 31, 2024. This extension aligns with a similar policy announced by the Centers for Medicare and Medicaid Services that extended telehealth flexibilities issued during the COVID-19 federal PHE for Medicare providers through Dec. 31, 2024.

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.

*On March 21, 2024 SCDHHS issued Medicaid bulletin 24-010 to announce that flexibilities continued for one year after the expiration of the federal PHE are now extended by SCDHHS through Dec. 31, 2024. This extension aligns with a similar policy announced by the Centers for Medicare and Medicaid Services that extended telehealth flexibilities issued during the COVID-19 federal PHE for Medicare providers through Dec. 31, 2024.

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.

*On March 21, 2024 SCDHHS issued Medicaid bulletin 24-010 to announce that flexibilities continued for one year after the expiration of the federal PHE are now extended by SCDHHS through Dec. 31, 2024. This extension aligns with a similar policy announced by the Centers for Medicare and Medicaid Services that extended telehealth flexibilities issued during the COVID-19 federal PHE for Medicare providers through Dec. 31, 2024.

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.

*On March 21, 2024 SCDHHS issued Medicaid bulletin 24-010 to announce that flexibilities continued for one year after the expiration of the federal PHE are now extended by SCDHHS through Dec. 31, 2024. This extension aligns with a similar policy announced by the Centers for Medicare and Medicaid Services that extended telehealth flexibilities issued during the COVID-19 federal PHE for Medicare providers through Dec. 31, 2024.

SOURCE: SC Dept. of Health and Human Services. Medicaid Bulletin 22-005. (May 2023); SC Dept. of Health and Human Services. Medicaid Bulletin 24-010. (Mar. 2024). (Accessed Aug. 2024).

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.

*On March 21, 2024 SCDHHS issued Medicaid bulletin 24-010 to announce that flexibilities continued for one year after the expiration of the federal PHE are now extended by SCDHHS through Dec. 31, 2024. This extension aligns with a similar policy announced by the Centers for Medicare and Medicaid Services that extended telehealth flexibilities issued during the COVID-19 federal PHE for Medicare providers through Dec. 31, 2024.

SOURCE: SC Dept. of Health and Human Services. Medicaid Bulletin Update on Occupational Therapy Telehealth Flexibilities. (Oct. 2022); SC Dept. of Health and Human Services. Medicaid Bulletin 24-010. (Mar. 2024). (Accessed Aug. 2024).

Nutritional Counseling Services

Nutritional counseling services are allowed to be performed via telehealth. A telehealth encounter must be billed with GT modifier, and it counts towards the twelve (12) hours of combined medical nutrition therapy services provided to a patient per fiscal year. Services delivered in-person or via telehealth by the same provider type will be reimbursed at the same rate.

For Federally Qualified Health Center Services, medical nutrition therapy is billable under the encounter rate. If the beneficiary is seen by a physician or mid-level provider and dietitian on the same day, one encounter can be billed for the services received that day.

For Rural Health Center Services, nutritional counseling services are also allowed to be performed via telehealth. However, medical nutrition therapy is not allowed to be billed using the encounter rate. All providers and dietitians are required to bill the appropriate CPT codes with a primary diagnosis code. The provider can either schedule the patient for an independent visit or may bill the initial medical nutrition therapy visit on the same day as a routine physical exam or E&M service. The subsequent individual or group nutrition therapy must be scheduled as independent visits. Medical nutrition therapy services performed in a RHC must be billed under the performing provider’s group NPI, not allowed to be billed under the RHC NPI.

SOURCE: SC Health and Human Svcs. Dept. Medicaid Bulletin 23-060, Dec. 2023 & SC Health and Human Svcs. Dept. Physicians Provider Manual, p. 212, 254, 257. (Aug. 2024). (Accessed Aug. 2024).

Interprofessional Consultation

SCDHHS will reimburse providers for interprofessional consultation services as distinct services under the Medicaid physician fee schedule.

Interprofessional consultation is defined as a situation in which the patient’s treating physician or other qualified health care practitioner (hereafter referred to as the treating practitioner) requests the opinion and/or treatment advice of a physician or other qualified health care practitioner with specific specialty expertise (hereafter referred to as the consulting practitioner) to assist the treating practitioner with the patient’s care.

Interprofessional consultation is intended to expand access to specialty care and foster interdisciplinary input on patient care. It is not intended to be a replacement for direct specialty care when such care is clinically indicated. Reimbursement of interprofessional consultation is permissible, even when the beneficiary is not present, as long as the consultation is for the direct benefit of the beneficiary. The consulting provider must be an enrolled Medicaid provider. Interprofessional consultation services may be provided via telehealth and reimbursed with the use of the appropriate modifier.

SOURCE: SC Health and Human Svcs. Dept. Medicaid Bulletin 23-063, Dec. 2023 & SC Health and Human Svcs. Dept. Physicians Provider Manual, p. 85-86. (Sept. 2024). (Accessed Aug. 2024).

Federally Qualified Health Center/Rural Health Center Services

FQHC/RHC providers are eligible to serve as referring site or consulting site providers for telehealth services.

When billing valid encounters provided by telehealth, FQHC/RHC providers must use POS code 02 with the encounter code T1015 as well as the procedure codes for the specific allowable services provided during the telemedicine encounter. Modifier GT is also required for all services provided via telehealth and must be recorded secondary to any other applicable modifiers.

See page 21 of manual for PHE limited telehealth codes.

SOURCE: SC Health and Human Svcs. Dept. Federally Qualified Health Center Provider Manual, p. 9, 16, 21. (Sept. 2024); SC Health and Human Svcs. Dept. Rural Health Clinic Provider Manual, p. 7, 13, 21. (Sept. 2024). (Accessed Sept. 2024).

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. In situations where a referral is not needed, the provider will not need to be confined to the definitions above.

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.

SOURCE: SC Health and Human Svcs. Dept. Physicians Provider Manual, p. 33-34, 193. (Sept. 2024) (Accessed Aug. 2024).

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.

*On March 21, 2024 SCDHHS issued Medicaid bulletin 24-010 to announce that flexibilities continued for one year after the expiration of the federal PHE are now extended by SCDHHS through Dec. 31, 2024. This extension aligns with a similar policy announced by the Centers for Medicare and Medicaid Services that extended telehealth flexibilities issued during the COVID-19 federal PHE for Medicare providers through Dec. 31, 2024.

SOURCE: SC Dept. of Health and Human Services. Medicaid Bulletin 22-005. (May 2023); SC Dept. of Health and Human Services. Medicaid Bulletin 24-010. (Mar. 2024). (Accessed Aug. 2024).

Federally Qualified Health Center/Rural Health Center Services

FQHC/RHC providers are eligible to serve as referring site or consulting site providers for telehealth services.

FQHCs/RHCs 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. For a limited time during the Public Health Emergency period, visits rendered via telehealth may be billed separately, in lieu of an encounter, under the FQHC/RHC provider NPI. Refer to the Special Clinic Services section of this manual.

SOURCE: SC Health and Human Svcs. Dept. Federally Qualified Health Center Provider Manual, p. 7, 20. (Sept. 2024); SC Health and Human Svcs. Dept. Rural Health Clinic Provider Manual, p. 7, 22. (Sept. 2024). (Accessed Sept. 2024).

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. 33, 35 (Sept. 2024). (Accessed Aug. 2024).

Local Education Agency Manual refers providers to the Physician Manual Policy.

SOURCE: SC Health and Human Svcs. Dept., Local Education Manual, p. 22. (Jan. 2023). (Accessed Aug. 2024).

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. 2024).

Federally Qualified Health Center/Rural Health Center Services

FQHC services are allowed to be performed in the following settings: …

• Telehealth or Telehealth at Home

SOURCE: SC Health and Human Svcs. Dept. Federally Qualified Health Center Provider Manual, p.13. (Sept. 2024). (Accessed Sept. 2024).

RHC services are allowed to be performed in the following settings:

• Telehealth

SOURCE: SC Health and Human Svcs. Dept. Rural Health Clinic Provider Manual, p. 13. (Sept. 2024). (Accessed Sept. 2024).

GEOGRAPHIC LIMITS

FACILITY/TRANSMISSION FEE

Last updated 08/26/2024

Miscellaneous

Last updated 08/26/2024

Out of State Providers

The provider performing the medical care must be currently and appropriately licensed in South Carolina.

SOURCE: SC Health and Human Svcs. Dept. Physicians Provider Manual, p. 33 (Sept. 2024). (Accessed Aug. 2024).

Behavioral Health

Office location(s) and the rendering of any service(s) must be located in South Carolina or within the SCMSA. Consulting site providers for telehealth psychiatry encounters are not subject to the SCMSA location requirement but must be enrolled in South Carolina Medicaid and have a South Carolina medical license.

SOURCE: SC Health and Human Svcs. Dept. Rehabilitative Behavioral Health Services Provider Manual, p. 12, 91. (Jul. 2024). (Accessed Aug. 2024).

Last updated 08/26/2024

Overview

South Carolina Medicaid reimburses for live video under certain circumstances. Store-and-forward does not appear to be reimbursed as it does not meet certain established conditions for coverage. However, CPT Code G2010 (remote images submitted by a patient) is listed as reimbursed for established patients. Interprofessional consultation services are also covered. Audio-only coverage for particular providers and codes implemented during the public health emergency has been extended through December 31, 2024. South Carolina Medicaid reimburses for telemonitoring in certain instances and recently added continuous glucose monitoring coverage as well.

Last updated 08/26/2024

Remote Patient Monitoring

POLICY

CONDITIONS

Continuous Glucose Monitoring

CGM will be covered with prior authorization (PA) that includes the following criteria.

1. Eligible Medicaid members must have one of the following clinical criteria:
   1. Type 1 diabetes mellitus;
   2. Gestational diabetes; or
   3. Type 2 diabetes with one of the following:
      1. Any type of insulin dependency or
      2. Non-insulin treated diabetes who have recurrent moderate (level 2) or have had at least one severe (level 3) hypoglycemic event

SOURCE: SC Health and Human Svcs. Dept. Provider Bulletin 24-036. (Jun. 2024); SC Health and Human Svcs. Dept. Physicians Provider Manual, p. 55 (Aug. 2024); SC Health and Human Svcs. Dept. Durable Medical Equipment Services Provider Manual, p. 7 (Jul. 2024). (Accessed Aug. 2024).

PROVIDER LIMITATIONS

Home and Community Based Services

Participants receiving the telemonitoring service must have a primary care physician that approves the use of the telemonitoring service and is solely responsible for receiving and acting upon the information received via the telemonitoring service.

SOURCE: SC Health and Human Svcs. Dept. HCBS Provider Manual, p. 32-33 (Jul. 2024). (Accessed Aug. 2024).

Continuous Glucose Monitoring

CGM will be covered with prior authorization (PA) that includes the following criteria.

1. CGM must be prescribed by one of the following qualified healthcare providers:
   1. primary care provider (a physician, physician assistant or advanced practice registered nurse);
   2. obstetrician; or
   3. endocrinologist

SOURCE: SC Health and Human Svcs. Dept. Provider Bulletin 24-036. (Jun. 2024); SC Health and Human Svcs. Dept. Physicians Provider Manual, p. 55 (Aug. 2024); SC Health and Human Svcs. Dept. Durable Medical Equipment Services Provider Manual, p. 7 (Jul. 2024). (Accessed Aug. 2024).

OTHER RESTRICTIONS

Home and Community Based Services

Telemonitoring equipment located in the participant’s home must, at a minimum, be an FDA Class II Hospital grade medical device that includes a computer/monitor that is programmable for a variety of disease states and for rate and frequency. The equipment must have a digital scale that measures accurately to at least 400 lbs. that is adaptable to fit a glucometer and a blood pressure cuff. All installed equipment must be able to measure, at a minimum, blood pressure, heart rate, oxygen saturation, blood glucose, and body weight.

Telephones, facsimile machines, and electronic mail systems do not meet the requirements of the definition of telemonitoring but may be utilized as a component of the telemonitoring system.

As communication of data occurs at scheduled daily “appointment times” and the information collected/sent is neither visible to others or remains stored on the device, the participant maintains constant control of their personal information within the residential environment.

SOURCE: SC Health and Human Svcs. Dept. HCBS Provider Manual, p. 32-33 (Jul. 2024). (Accessed Aug. 2024).

Continuous Glucose Monitoring

The treating provider must evaluate the patient on an annual basis to consider patient’s compliance and determine the necessity of continuation of CGM.

SOURCE: SC Health and Human Svcs. Dept. Durable Medical Equipment Services Provider Manual, p. 7 (Jul. 2024).(Accessed Aug. 2024).

Last updated 08/26/2024

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