South Carolina

At A Glance
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MEDICAID REIMBURSEMENT

  • Live Video: Yes
  • Store-and-Forward: No
  • Remote Patient Monitoring: Yes
  • Audio Only: Yes

PRIVATE PAYER LAW

  • Law Exists: No
  • Payment Parity: No

PROFESSIONAL REQUIREMENTS

  • Licensure Compacts: EMS, NLC, PTC
  • Consent Requirements: Yes

STATE RESOURCES

  1. Medicaid Program: South Carolina Medicaid
  2. Administrator: South Carolina Health and Human Services Dept.
  3. Regional Telehealth Resource Center: Southeastern Telehealth Resource Center

Last updated 03/22/2022

Audio-Only Delivery

Medicaid: Telehealth COVID-19 Codes

STATUS: Active

Medicaid: Telehealth Policy Updates for Physicians, NPs, PAs and LIPs

STATUS: Active, until end of PHE

Medicaid: Telehealth Policy Update to PT, OT, and ST Coverage

STATUS: Active, until end of PHE

Medicaid: Telehealth Policy Update to Behavioral Health Coverage

STATUS: Active, until end of PHE

Medicaid: Telehealth Policy Update to Early Intervention Coverage

STATUS: Active, until end of federally declared public health emergency unless rescinded or superseded by SCDHHS prior to the end of the emergency.

Medicaid: Telehealth Policy Update to ABA Coverage

STATUS: Active, until end of federally declared public health emergency unless rescinded or superseded by SCDHHS prior to the end of the emergency.

Medicaid: Frequently Asked Questions

STATUS: Active

1135 Waiver: Community Choices (CC), HIV/AIDS, and Mechanical Ventilator Dependent (VENT)

STATUS: Active, expires no later than six months after the expiration of the PHE (see extension)

1135 Waiver: Palmetto Coordinated System of Care (PCSC)

STATUS: Active, expires no later than six months after the expiration of the PHE

Last updated 03/22/2022

Cross State Licensing

No Reference Found

Last updated 03/22/2022

Easing Prescribing Requirements

Medical Board: Emergency Order on Prescribing via Telemedicine

STATUS: Expired

Medical Board: Emergency Order on Medication-Assisted Treatment via telemedicine

STATUS: Expired

Medicaid: Coverage for the Treatment of Opioid Use Disorder

STATUS: Active, until end of PHE

Last updated 03/22/2022

Miscellaneous

Medicaid: Documentation Requirements

STATUS: Active

Medicaid: Telehealth Documentation and Platform Requirements

STATUS: Active

Medicaid 1915(c) Waiver: Extension of Intellectually Disabled and Related Disabilities (ID/RD), Community Supports (CS), Head and Spinal Cord Injury (HASCI), Community Choices (CC), HIV/AIDS, Mechanical Ventilator Dependent (VENT), Medically Complex Children (MCC)

STATUS: Active, expires no later than six months after the expiration of the PHE

Last updated 03/22/2022

Originating Site

Medicaid: Healthy Connections Medicaid Member Update

STATUS: Active, until end of PHE

Medicaid: FAQ

STATUS: Active, until end of the PHE

Last updated 03/22/2022

Private Payer

Department of Insurance: Health Issuers Response to COVID-19

STATUS: Varies

Last updated 03/22/2022

Provider Type

Medicaid: COVID-19 Telehealth Policy Update

STATUS: Active, until end of PHE

Medicaid: Frequently Asked Questions

STATUS: Active, until end of PHE

Medicaid: Telehealth COVID-19 Codes

STATUS: Active

Medicaid: Telehealth Policy Updates for Physicians, NPs, PAs and LIPs

STATUS: Active, until end of PHE

Medicaid: Telehealth Policy Update to PT, OT, and ST Coverage

STATUS: Active, until end of PHE

Medicaid: Telehealth Policy Update to Behavioral Health Coverage

STATUS: Active, until end of PHE

Medicaid: Telehealth Policy Update to Early Intervention Coverage

STATUS: Active, until end of federally declared public health emergency unless rescinded or superseded by SCDHHS prior to the end of the emergency.

Medicaid: Additional Telehealth Guidance for Early Intervention Coverage

STATUS: Active, until end of federally declared public health emergency unless rescinded or superseded by SCDHHS prior to the end of the emergency.

Medicaid: Telehealth Policy Update to ABA Coverage

STATUS: Active, until end of federally declared public health emergency unless rescinded or superseded by SCDHHS prior to the end of the emergency.

Medicaid: COVID-19 Update to Temporary Telehealth Coverage Changes for FQHCs and RHCs

STATUS: Active, until end of PHE

Medicaid: COVID-19 Telehealth Policy Update to Associate-level Provider Coverage

STATUS: Active for the duration of the federally declared public health emergency unless rescinded or superseded by SCDHHS prior to the end of the emergency.

 

Last updated 03/22/2022

Service Expansion

Medicaid: Baby Net Telehealth Evaluations

STATUS: Active

Medicaid: Telehealth COVID-19 Codes

STATUS: Active

Medicaid: Telehealth Policy Updates for Physicians, NPs, PAs and LIPs

STATUS: Active, until end of PHE

Medicaid: Telehealth Policy Update to PT, OT, and ST Coverage

STATUS: Active, until end of PHE

Medicaid: Telehealth Policy Update to Behavioral Health Coverage

STATUS: Active, until end of PHE

Medicaid: Telehealth Policy Update to Early Intervention Coverage

STATUS: Active, until end of federally declared public health emergency unless rescinded or superseded by SCDHHS prior to the end of the emergency.

Medicaid: Additional Telehealth Guidance for Early Intervention Coverage

STATUS: Active, until end of federally declared public health emergency unless rescinded or superseded by SCDHHS prior to the end of the emergency.

Medicaid: Telehealth Policy Update to ABA Coverage

STATUS: Active, until end of federally declared public health emergency unless rescinded or superseded by SCDHHS prior to the end of the emergency.

Medicaid: COVID-19 Update to Temporary Telehealth Coverage Changes for FQHCs and RHCs

STATUS: Active, until end of PHE

1135 Waiver: Palmetto Coordinated System of Care (PCSC)

STATUS: Active, expires no later than six months after the expiration of the PHE

Frequently Asked Questions

STATUS: Active

Last updated 03/22/2022

Definition

“Telemedicine is the use of medical information about a patient that is exchanged from one site to another via electronic communications to provide medical care to a patient in circumstances in which face-to-face contact is not necessary. In this instance, a physician or other qualified medical professional has determined that medical care can be provided via electronic communication with no loss in the quality or efficacy of the 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 physician or practitioner at the referring site. Telemedicine includes consultation, diagnostic, and treatment services.”

SOURCE: SC Health and Human Svcs. Dept., Physicians Provider Manual, p. 27-28 (March 2022), (Accessed March 2022). 

Last updated 03/22/2022

Email, Phone & Fax

No reimbursement for email.
No reimbursement for telephone.
No reimbursement for FAX.
No reimbursement for video cell phone interactions.

SOURCE: SC Health and Human Svcs. Dept. Physicians Provider Manual, p. 157 (March 2022). (Accessed March 2022).

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. 25, (July 2019), (Accessed March 2022).

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 March 2022).

Dental Telephonic Encounters
As of July 1, 2021, patient triage and care coordination via telephonic or telehealth encounter, along with oral evaluations performed in conjunction with the telehealth encounters, will no longer be allowed.

Source: SC Health and Human Svcs. Dental Services Provider Manual. (Jan. 2022). Pg. 82. (Accessed March 2022).

Licensed Independent Practitioner’s Rehabilitative Services.
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.

Crisis Management (CM) is a face-to-face, or telephonic, short-term service is to assist a beneficiary, who is experiencing a marked deterioration of functioning related to a specific precipitant, in restoring his/her level of functioning and/or to stabilize the beneficiary.

Telephonic interventions 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

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.

Telephone contact related to office procedures or appointment times are not covered.

Last updated 03/22/2022

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.

SOURCE: SC Health and Human Svcs. Dept. Physicians Provider Manual, p. 29 (March 2022). (Accessed March 2022).

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.

SOURCE: SC Health and Human Svcs. Dept. Physicians Provider Manual, p. 28 (March 2022). (Accessed March 2022).

Telemedicine equipment and transmission must permit encrypted transmission and the speed and image resolution must be technically sufficient to support the service billed. Staff involved in a telemedicine visit must be trained in the use of the telemedicine equipment and component 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.

Telepsychiatry

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. 20. (Oct. 2021). (Accessed March 2022). 


ELIGIBLE SERVICES/SPECIALTIES

Eligible services include consultation, diagnostic, and treatment services:

  • Office or other outpatient visits;
  • Inpatient consultation;
  • Individual psychotherapy;
  • Psychiatric diagnostic interview examination;
  • Neurobehavioral status examination;
  • Electrocardiogram interpretation and report only;
  • Echocardiography.

Services provided by allied health professionals are not covered.

Telemedicine services are not an expansion of covered services, but an option for the delivery of certain covered services.

SOURCE: SC Health and Human Svcs. Dept. Physicians Provider Manual, p. 28, 30 & 157 (March 2022). (Accessed March 2022).

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. 26, (March 2022). (Accessed March 2022).

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 March 2022).

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 (Oct. 2021). (Accessed March 2022). 

Autism Spectrum Disorder
Telehealth is not covered.

SOURCE: SC Health and Human Svcs. Autism Spectrum Disorder Provider Manual, p. 19 (Apr. 2021). (Accessed March 2022).

Dental Telephonic or Telehealth Encounters
As of July 1, 2021, patient triage and care coordination via telephonic or telehealth encounter, along with oral evaluations performed in conjunction with the telehealth encounters, will no longer be allowed.

SOURCE: SC Health and Human Svcs. Dental Services Provider Manual. (Jan. 2022), Pg. 82. (Accessed March 2022).


ELIGIBLE PROVIDERS

Distant site eligible, reimbursed providers:

  • Physicians;
  • Nurse practitioners;
  • Physician Assistants.

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 telemedicine. The health professional providing the medical care must be currently and appropriately licensed in South Carolina and located within the South Carolina Medical Service Area (SCMSA), which is defined as the State of South Carolina and areas in North Carolina and Georgia within 25 miles of the South Carolina State border.

SOURCE: SC Health and Human Svcs. Dept. Physicians Provider Manual, p. 28. (March 2022) (Accessed March 2022).

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. 215. (March 2022). (Accessed March 2022).


ELIGIBLE SITES

Eligible originating (referring) sites:

  • Practitioner offices (physician, NP, CNM or PA);
  • Hospitals (inpatient and outpatient);
  • Rural Health Clinics;
  • Federally Qualified Health Centers;
  • Community Mental Health Centers;
  • Public Schools;
  • Act 301 Behavioral Health Centers.

Referring sites (also known as originating sites) must be located in the South Carolina Medical Service Area, which is the state of SC and areas in NC and GA within 25 miles of the SC border.

SOURCE: SC Health and Human Svcs. Dept., Physicians Provider Manual, p. 28 (March 2022). (Accessed March 2022).

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

SOURCE: Local Education Manual, p. 26. (March 2022). (Accessed March 2022).

An appropriate certified or licensed 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.

SOURCE: SC Health and Human Svcs. Dept. Physicians Provider Manual, p. 30 (March 2022). (Accessed March 2022).


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 telemedicine. The health professional providing the medical care must be currently and appropriately licensed in South Carolina and located within the South Carolina Medical Service Area (SCMSA), which is defined as the State of South Carolina and areas in North Carolina and Georgia within 25 miles of the South Carolina State border.


FACILITY/TRANSMISSION FEE

The referring site is only eligible to receive a facility fee for telemedicine services. Claims are submitted with HCPCS code. If a provider from the referring site performs a separately identifiable service for the beneficiary on the same day as telemedicine, 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 a facility fee for telemedicine services when operating as the referring site. They may not bill the encounter code if these are the only services being rendered.

Hospital providers are eligible to receive a facility fee for telemedicine when operating as the referring site. Claims must be submitted with the appropriate telemedicine revenue code.

Last updated 03/22/2022

Miscellaneous

If a beneficiary is a minor child, a parent and/or guardian must present the child for telemedicine services unless otherwise exempted by State or Federal law. The parent and/or guardian need not attend the telemedicine session unless attendance is therapeutically appropriate.

Documentation in the medical records must be maintained at the referring and consulting locations to substantiate the service provided. A request for a telemedicine service from a referring provider and the medical necessity for the telemedicine service must be documented in the beneficiary’s medical record. Documentation must indicate the services were rendered via telemedicine. All applicable documentation requirements for services delivered face-to-face also apply to services rendered via telemedicine.

The beneficiary must have access to all transmitted medical information, with the exception of live interactive video, as there is often no stored data in such encounters.

Last updated 03/22/2022

Out of State Providers

No Reference Found

Last updated 03/22/2022

Overview

South Carolina Medicaid reimburses for live video under certain circumstances. Store-and-forward is not reimbursed as it does not meet established conditions for the use of telemedicine. South Carolina Medicaid reimburses for home health monitoring through the Home Aging Program for some conditions when a patient is eligible.

Last updated 03/22/2022

Remote Patient Monitoring

POLICY

An order or referral is required for South Carolina Medicaid Telemonitoring services.


CONDITIONS

No Reference Found


PROVIDER LIMITATIONS

No Reference Found


OTHER RESTRICTIONS

No Reference Found

Last updated 03/22/2022

Store and Forward

POLICY

South Carolina Medicaid will not reimburse for store-and-forward due to the requirements that the beneficiary must be present and participating in the visit and interactive audio and video telecommunication must be used.


ELIGIBLE SERVICES/SPECIALTIES

No Reference Found


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

Last updated 03/22/2022

Definition

No Reference Found

Last updated 03/22/2022

Parity

SERVICE PARITY

No Reference Found


PAYMENT PARITY

No Reference Found

Last updated 03/22/2022

Requirements

No Reference Found

Last updated 03/22/2022

Cross State Licensing

The physician must be licensed in South Carolina; however, they do not need to reside in South Carolina.

Last updated 03/22/2022

Definitions

Telemedicine means the practice of medicine using electronic communications, information technology, or other means between a licensee in one location and a patient in another location with or without an intervening practitioner.

South Carolina law addresses telemedicine under veterinary services, stating, “telemedicine is an audio, video, or data communication of medical information.”

Last updated 03/22/2022

Licensure Compacts

Member of the Physical Therapy Compact

SOURCE: Compact Map. Physical Therapy Compact. (Accessed March 2022).

Member of the Nurse Licensure Compact.

SOURCE: Current NLC States & Status. Nurse Licensure Compact. (Accessed March 2022).

Member of Emergency Medical Services (EMS) Compact.

SOURCE: Interstate Commission for EMS Personnel Services, Compact Member States, (Accessed March 2022).

 

* See Compact websites for implementation and license issuing status and other related requirements.

Last updated 03/22/2022

Miscellaneous

No Reference Found

Last updated 03/22/2022

Online Prescribing

A licensee shall not establish a physician-patient relationship by telemedicine for the purpose of prescribing medication when an in-person physical examination is necessary for diagnosis.

Schedule II and Schedule III prescriptions are not permitted except for those Schedule II and Schedule III medications specifically authorized by the board, which may include, but not be limited to, Schedule II-nonnarcotic and Schedule III-nonnarcotic medications.

To establish a physician-patient relationship via telemedicine, the provider must:

    • Comply with state and federal laws on patient confidentiality
    • Adhere to current standards of practice improvement and monitoring of outcomes and provide reports containing such information upon request of the board;
    • Provide an appropriate evaluation prior to diagnosing and/or treating the patient, which need not be done in-person if the licensee employs technology sufficient to accurately diagnose and treat the patient in conformity with the applicable standard of care; provided, that evaluations in which a licensee is at a distance from the patient, but a practitioner is able to provide various physical findings the licensee needs to complete an adequate assessment, is permitted; further, provided, that a simple questionnaire without an appropriate evaluation is prohibited;
    • Verify the identity and location of the patient and be prepared to inform the patient of the licensee’s name, location and professional credentials;
    • Establish a diagnosis through the use of accepted medical practices, which may include patient history, mental status evaluation, physical examination, and appropriate diagnostic and laboratory testing in conformity with the applicable standard of care;
    • Ensure availability of follow-up care and maintain a complete medical record that is available to the patient and other treating health care practitioners, to be distributed to other treating health care practitioners only with patient consent and in accordance with applicable law and regulation;
    • Prescribe within a practice setting fully in compliance with the law and during an encounter in which threshold information necessary to make an accurate diagnosis has been obtained in a medical history interview conducted by the prescribing licensee. See Code for specific information on controlled substances.
    • Maintain a complete record of the patient’s care according to prevailing medical record standards that reflects an appropriate evaluation of the patient’s presenting symptoms; provided that relevant components of the telemedicine interaction be documented as with any other encounter;
    • Maintain the patient’s records’ confidentiality and disclose the records to the patient consistent with state and federal law; provided, that licensees practicing telemedicine shall be held to the same standards of professionalism concerning medical records transfer and communication with the primary care provider and medical home as licensees practicing via traditional means; further, provided, that if a patient has a primary care provider and a telemedicine provider for the same ailment, then the primary care provider’s medical record and the telemedicine provider’s record constitute one complete medical record;
    • Be licensed to practice in South Carolina provided, however, a licensee need not reside in South Carolina so long as he or she has a valid, current South Carolina medical license; further, provided, that a licensee residing in South Carolina who intends to practice medicine via telemedicine to treat or diagnose patients outside of South Carolina shall comply with other state licensing boards; and
    • Discuss with the patient the value of having a primary care medical home and, if the patient requests, provide assistance in identifying available options for a primary care medical home.

A licensee, practitioner, or any other person involved in a telemedicine encounter must be trained in the use of the telemedicine equipment and competent in its operation.

Schedule II and III prescriptions are not permitted except as specifically authorized by the board.

Prescribing abortion-inducing drugs is not permitted; as used in this article “abortion-inducing drug” means a medicine, drug, or any other substance prescribed or dispensed with the intent of terminating the clinically diagnosable pregnancy of a woman, with knowledge that the termination will with reasonable likelihood cause the death of the unborn child.

SOURCE: SC Code Annotated Sec. 40-47-37. (Accessed March 2022).

Last updated 03/22/2022

Professional Board Standards

South Carolina Board of Examiners in Psychology*

SOURCE: Telehealth Statement, March 11, 2019. (Accessed March 2022)

South Carolina Board of Physical Therapy Examiners*

SOURCE: Advisory Opinion On The Use Of Telehealth, Oct. 28, 2020. (Accessed March 2022)

South Carolina Board of Occupational Therapy*

SOURCE: Advisory Opinion On The Use Of Telehealth, June 12, 2020 (Accessed March 2022).

South Carolina Board of Examiners in Speech-Language Pathology and Audiology*

SOURCE: Policy Regarding Telepractice, 2018. (Accessed March 2022).

 

* The policies above are not official law or regulation, however are ‘advisory opinions’ or statements released by specific boards in the state on telehealth.