South Carolina

Disclaimer

PLEASE NOTE: CCHP is providing the following for informational purposes only. We are not providing legal advice or interpretation of the laws and regulations and policies. CCHP encourages you to check with the appropriate state agency for further information and direction. This information should not be construed as legal counsel. Consult with an attorney if you are seeking a legal opinion.

At A Glance
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MEDICAID REIMBURSEMENT

  • Live Video: Yes
  • Store-and-Forward: Yes* (CTBS Only)
  • Remote Patient Monitoring: Yes
  • Audio Only: Yes

PRIVATE PAYER LAW

  • Law Exists: No
  • Payment Parity: No

PROFESSIONAL REQUIREMENTS

  • Licensure Compacts: ASLP-IC, CC, EMS, NLC, OT, PSYPACT, PTC
  • Consent Requirements: No

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
Disclaimer

PLEASE NOTE: CCHP is providing the following for informational purposes only. We are not providing legal advice or interpretation of the laws and regulations and policies. CCHP encourages you to check with the appropriate state agency for further information and direction. This information should not be construed as legal counsel. Consult with an attorney if you are seeking a legal opinion.

Last updated 08/26/2024

Definition

No Reference Found

Last updated 08/26/2024

Parity

SERVICE PARITY

No Reference Found


PAYMENT PARITY

No Reference Found

Last updated 08/26/2024

Requirements

No Reference Found

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).

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. Associate-level providers should continue to request reimbursement under supervising clinician’s enrollment and follow other billing guidance as articulated in this manual. Services rendered via telehealth must include a GT modifier.

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 interventions require immediate response by a clinical professional and include telephonic interventions that are provided either to the member or on behalf of the member 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. 58-59, 91. (Jul. 2024); SC Health and Human Svcs. Dept. Licensed Independent Practitioner’s Rehabilitative Provider Manual, p. 14, 20-21. (Nov. 2023). (Accessed Aug. 2024).

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 08/26/2024

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).

Telepsychiatry

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 20-00920-014 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. 2023SC 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. 2023SC 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

A consultant site (also called the distant site) is the site at which the provider is located at the time the telehealth service. The provider performing 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.

A referring site (also called the patient site) is the location of an eligible Medicaid beneficiary at the time the telehealth service is being furnished. Medicaid beneficiaries are eligible for telehealth services only if they are presented from a referring site located in the SCMSA.


FACILITY/TRANSMISSION FEE

The referring site, also known as the originating 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.

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.

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

Federally Qualified Health Center/Rural Health Center Services

FQHCs/RHCs 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 referring site facility fee. When serving as the referring site, the FQHC/RHCs cannot bill the encounter code if these are the only services rendered.

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

Last updated 08/26/2024

Miscellaneous

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.

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 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.

Documentation in the medical records must be maintained at the referring and consulting locations to substantiate the service provided. A request for a telehealth service from a referring provider and the medical necessity for the telehealth service must be documented in the beneficiary’s medical record. Documentation must indicate the services were rendered via telehealth. All applicable documentation requirements for services delivered face-to-face also apply to services rendered via telehealth. Examples may include but are not limited to the following based on provider specialty:

  • The diagnosis and treatment plan resulting from the telehealth service and progress note by the health care provider.
  • The location of the referring site and consulting site.
  • Documentation supporting the medical necessity of the telehealth service.
  • Start and stop times.

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

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

SOURCE: SC Health and Human Svcs. Dept. Provider Administrative and Billing Manual, p. 12-13 (Jul. 2024). (Accessed Aug. 2024).

Home and Community Based Services

Tele-Monitoring service utilizing technologies which measure and report the health status of at-risk waiver participants. This is done remotely by utilizing either existing telephone infrastructure or wireless communication technology in collecting and transmitting physiological data between the provider and participant. Monitoring is the primary purpose of this service. Remote monitoring will assist the individual to fully integrate into the community, participate in community activities, and avoid isolation.

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

Continuous Glucose Monitoring

Effective for dates of service on or after July 1, 2024, the South Carolina Department of Health and Human Services (SCDHHS) is expanding its existing coverage of continuous glucose monitoring (CGM) for full-benefit Healthy Connections Medicaid members. CGM will be covered under either the pharmacy or durable medical equipment (DME) State Plan benefit.

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).

CGM measures glucose levels in real-time. An electrode called a sensor is inserted under the skin to measure glucose levels in interstitial fluid. The sensor is connected to a transmitter which sends the information wirelessly to a monitoring and display device. The monitoring system may be either a stand-alone system or it may be integrated into an external insulin pump.

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

Acute Hospital Care at Home

“Acute hospital care at home” means acute-level hospital care to treat a subset of diagnoses that respond safely and effectively to home-based acute care, utilizing technology to provide continuous remote patient monitoring and connectivity to the patient and developing in-home services to ensure the same level of care in the home as in a traditional hospital stay as well as patient safety. Acute hospital care at home must be provided by a hospital licensed in this State pursuant to this article to eligible patients who have provided consent to such care, utilizing a multidisciplinary team to deliver the care.

Acute hospital care at-home programs and services delivered by a licensed acute care hospital are exempted from Certificate of Need review. The delivery of acute hospital care at-home programs and services by a licensed acute care hospital does not require a written exemption from the department. Additionally, patients enrolled in the hospital care at-home program shall not be considered within the licensed bed capacity of the hospital participating in the program.

The department shall promulgate regulations for licensing an acute care hospital’s acute hospital care at home programs and services. At a minimum, the regulations must address:

  1. diagnoses that respond safely and effectively to home-based acute care;
  2. patient eligibility criteria and screening requirements, including patient consent;
  3. multidisciplinary team requirements, including roles and responsibilities of team members;
  4. standards for continuous remote patient monitoring and connectivity with the patient;
  5. standards for the development of in-home services to ensure same level of care in the home as in a traditional hospital stay; and
  6. standards for patient safety.

SOURCE: SC Code Sec. 44-7-130(25), SC Code Sec. 44-7-170(A)(4), SC Code Sec. 44-7-267 as proposed to be added and amended by S 858 (2024 Session). (Accessed Aug. 2024).


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

Store and Forward

POLICY

G2010 (Remote image submitted by a patient) is listed as reimbursed for established patients.

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

South Carolina Medicaid coverage guidelines appear to exclude reimbursement 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. However, the coverage guidelines also state that any exemptions to this condition (such as interprofessional consultation services) will be otherwise listed under the exempted service section of the Physician Services Provider Manual respectively.

SOURCE: SC Health and Human Svcs. Dept. Physicians Provider Manual, p. 34-35 (Sept. 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. 2023SC Health and Human Svcs. Dept. Physicians Provider Manual, p. 85-86. (Sept. 2024). (Accessed Aug. 2024).


ELIGIBLE SERVICES/SPECIALTIES

No Reference Found


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

Last updated 08/26/2024

Cross State Licensing

A licensee who provides care, renders a diagnosis, or otherwise engages in the practice of medicine as defined in Section 40-47-20(36) via telemedicine as defined in Section 40-47-20(52) shall:

  1. be licensed to practice medicine in this State; provided, however, a licensee need not reside in this State if he has a valid, current South Carolina medical license; further, provided, that a licensee who resides in this State and intends to practice medicine via telemedicine to treat or diagnose patients outside of this State shall comply with other applicable state licensing boards; and
    • this requirement is not applicable to an informal consultation or second opinion, at the request of a physician licensed to practice medicine in this State, provided that the physician requesting the opinion retains the authority and responsibility for the patient’s care; and
    • where an in-person physician-patient relationship is established in another state for specialty care and treatment is ongoing by that out-of-state provider, care provided pursuant to an existing treatment plan via telehealth in this State by the out-of-state provider between in-person visits is considered acts incidental to the care of the patient in another state and the out-of-state provider is not required to be licensed in this State. This exception may not be construed to apply to:
      • episodic care that is provided by an out-of-state provider;
      • new health conditions that arise and are not connected to the condition being treated by the out-of-state provider; or
      • care provided by an out-of-state provider for extended periods of time without intervening in-person visits; and
    • for purposes of subitems (a) and (b), the care provided to the patient by the out-of-state provider is deemed to have occurred where the patient was located at the time health care services were provide to him by means of telehealth; and
    • shall maintain a controlled substances registration with South Carolina’s Bureau of Drug Control if prescribing controlled substances.

Nothing in this section may be construed to prohibit electronic communications between:

  1. a physician and patient with a preexisting physician-patient relationship;
  2. a physician and another physician concerning a patient with whom the other physician has a physician-patient relationship; or
  3. a provider and a patient when treatment is provided pursuant to an on-call situation or a cross-coverage situation.

Notwithstanding any of the provisions of this section, the board shall retain all authority with respect to telemedicine practice as granted in Section 40-47-10(I) of this chapter.

SOURCE: SC Code Annotated Sec. 40-47-37 as amended by H 4159 (2024 Session). (Accessed Aug. 2024).

A licensee who provides health care via telehealth must be licensed in this State; provided however, a licensee need not reside or maintain a physical office in this State to be considered actively practicing medicine if he has a valid, current license issued by the applicable licensing board in this State; further provided that a licensee residing in this State who intends to practice via telehealth to treat or diagnose patients outside of this State shall comply with other state licensing boards; and shall maintain a controlled substances registration with South Carolina’s Bureau of Drug Control if prescribing controlled substances.

Nothing in this section may be construed to prohibit electronic communications between a licensee and patient with a preexisting licensee-patient relationship, between a licensee and another licensee concerning a patient with whom the other licensee has a licensee-patient relationship, or between a licensee and a patient when treatment is provided pursuant to an on-call situation or a cross-coverage situation.

Notwithstanding any of the provision of this section, a licensee’s respective licensing board retains all authority with respect to telehealth practice in accordance with the authorization provided to him by his respective practice act.

SOURCE: SC Code Annotated Sec. 40-42-20 as proposed to be added by H 4159 (2024 Session). (Accessed Aug. 2024).

A person providing social work services to a client in this State, through telephonic, electronic, or other means, regardless of the location of the social worker, who is not licensed or registered in this State, is practicing without a license. A social worker licensed by this State may provide services through these means to a client in this State within their appropriate scope of practice.

SOURCE: SC Code Annotated Sec. 40-63-30(B). (Accessed Aug. 2024).

For purposes of this section, ‘behavioral telehealth’ means the practice of Independent Social Work‑CP using electronic communications, information technology, or other means between a registrant located outside this State and a client located in this State with or without an intervening practitioner. A behavioral telehealth provider has the duty to practice in a manner consistent with his scope of practice and the prevailing professional standard of practice for an Independent Social Work‑CP who provides in‑person social work services to clients in this State.

An Independent Social Work‑CP who holds an active license to provide independent social work services in another state or jurisdiction may provide independent social work services using behavioral telehealth to a client located in this State if the individual is registered with the board and provides the services within the applicable scope of practice established by this State.

To be registered, the individual must:

  1. complete an application in the format prescribed by the board;
  2. be licensed with an active, unencumbered license that is issued by another state, the District of Columbia, or a possession or territory of the United States and that is substantially similar to a license issued by South Carolina to an Independent Social Worker‑CP;
  3. have not been the subject of disciplinary action relating to his license during the five‑year period immediately prior to the submission of the application; and
  4. pay a ten dollar fee.

The website of a behavioral telehealth registrant must prominently display a hyperlink to the board’s website list of registrants and related information.

The individual may not register under this section if his license to provide social work services is subject to a pending disciplinary investigation or action or has been revoked in any state or jurisdiction. A social worker registered under this section must notify the board of restrictions placed on his license to practice, or any disciplinary action taken or pending against him, in any state or jurisdiction. The notification must be provided within five business days after the restriction is placed or disciplinary action is initiated or taken.

The board shall publish on its website a list of all registrants and include, to the extent applicable, each registrant’s name, address, out‑of‑state social work license type with the license number, and South Carolina behavioral telehealth registration number.

The board may take disciplinary action against an out‑of‑state registrant registered under this section if the individual:

  1. fails to notify the board of any adverse actions taken against his license
  2. has restrictions placed on or disciplinary action taken against his license in any state or jurisdiction;
  3. violates any of the requirements of this section; or
  4. commits any act that constitutes grounds for disciplinary action under the board’s statutes or regulations.

For the purposes of this section, the delivery of behavioral telehealth services by a registrant licensed by another state or jurisdiction to a client residing in this State is deemed to occur in this State, and the registrant consents, as a condition of registration, to the personal and subject matter jurisdiction and disciplinary authority of the board.

Nothing in this section requires or authorizes an individual licensed by this State pursuant to this chapter to obtain a behavioral telehealth registration in order to provide behavioral telehealth services to a client residing in this State.

SOURCE: SC Code Annotated Sec. 40-63-35. (Accessed Aug. 2024).

For purposes of this chapter, ‘behavioral telehealth’ means the practice of professional counseling, addiction counseling, marriage and family therapy, and licensed psycho‑educational specialty using electronic communications, information technology, or other means between a registrant located outside this State and a client located in this State with or without an intervening practitioner. A behavioral telehealth provider has the duty to practice in a manner consistent with his scope of practice and the prevailing professional standard of practice for a behavioral health care professional who provides in‑person professional counseling, addiction counseling, marriage and family therapy, and licensed psycho‑educational specialist services to clients in this State.

Individuals who hold an active license to provide professional counseling, addiction counseling, marriage and family therapy, and licensed psycho‑educational specialist services in another state or jurisdiction may provide these services using behavioral telehealth to a client located in this State if the individual is registered with the board and provides the services within the applicable scope of practice established by this State.

To be registered, the individual must:

  1. complete an application in the format prescribed by the board;
  2. be licensed with an active, unencumbered license that is issued by another state, the District of Columbia, or a possession or territory of the United States and that is substantially similar to a license issued by South Carolina to a professional counselor, addiction counselor, marriage and family therapist, or licensed psycho‑educational specialist;
  3. have not been the subject of disciplinary action relating to his license during the five‑year period immediately prior to the submission of the application; and
  4. pay a ten dollar fee.

The website of a behavioral telehealth registrant must prominently display a hyperlink to the board’s website list of registrants and related information.

The individual may not register under this subsection if his license to provide professional counseling, addiction counseling, marriage and family therapy, or licensed psycho‑educational specialist services is subject to a pending disciplinary investigation or action, or has been revoked in any state or jurisdiction. An individual registered under this section must notify the board of restrictions placed on his license to practice or any disciplinary action taken or pending against him in any state or jurisdiction. The notification must be provided within five business days after the restriction is placed or disciplinary action is initiated or taken.

The board shall publish on its website a list of all registrants and include, to the extent applicable, each registrant’sname, address, out‑of‑state professional license type with the license number, and South Carolina behavioral telehealth registration number.

The board may take disciplinary action against an out‑of‑state registrant registered under this section if the individual:

  1. fails to notify the board of any adverse actions taken against his license
  2. has restrictions placed on or disciplinary action taken against his license in any state or jurisdiction;
  3. violates any of the requirements of this section; or
  4. commits any act that constitutes grounds for disciplinary action under the board’s statutes or regulations.

For the purposes of this section, the delivery of behavioral telehealth services by a registrant licensed by another state or jurisdiction to a client residing in this State is deemed to occur in this State, and the registrant consents, as a condition of registration, to the personal and subject matter jurisdiction and disciplinary authority of the board.

Nothing in this section requires or authorizes an individual licensed by this State pursuant to this chapter to obtain a behavioral telehealth registration in order to provide behavioral telehealth services to a client residing in this State.

SOURCE: SC Code Annotated Sec. 40-75-800. (Accessed Aug. 2024).

Physician assistants are authorized to perform telemedicine and telehealth in accordance with the requirements of Section 40-47-37 including, but not limited to, Section 40-47-37(C)(6) requiring board authorization prior to prescribing Schedule II and Schedule III prescriptions; Section 40-47-113, approved written scope of practice guidelines, and pursuant to all physician supervisory requirements imposed by this chapter without having to be licensed to practice medicine in this State as otherwise required in Section 40-47-37(A)(4).

SOURCE: SC Code Annotated Sec. 40-47-935 as amended by H 4159 (2024 Session). (Accessed Aug. 2024).

An advanced practice registered nurse may perform medical acts via telemedicine and telehealth pursuant to a practice agreement as defined in Section 40-33-20(45) without having to be licensed to practice medicine in this State as otherwise required in Section 40-47-37(A)(4).

SOURCE: SC Code Annotated Sec. 40-33-34(I)(2) as amended by H 4159 (2024 Session). (Accessed Aug. 2024).

Last updated 08/26/2024

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.

Telehealth means the use of electronic communications, information technology, or other means to deliver health care, patient and professional health-related education, public health, and health administration between a licensee in one location and a patient in another location with or without an intervening practitioner.

SOURCE: SC Code Annotated Sec. 40-47-20 (52-53) & SC Code Annotated Sec. 40-42-10 as proposed to be amended and added by H 4159 (2024 Session). (Accessed Aug. 2024).

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

Last updated 08/26/2024

Licensure Compacts

Member of Audiology and Speech-Language Pathology Interstate Compact

SOURCE: ASLP-IC Compact Map. (Accessed Aug. 2024).

Member of Counseling Compact

SOURCE: Senate Bill 610. Counseling Compact Map. (Accessed Aug. 2024).

Member of Emergency Medical Services (EMS) Compact

SOURCE: Interstate Commission for EMS Personnel Services, Compact Member States, (Accessed Aug. 2024).

Member of the Nurse Licensure Compact

SOURCE: Current NLC States & Status. Nurse Licensure Compact. (Accessed Aug. 2024).

Member of Occupational Therapy Licensure Compact

SOURCE: OT Compact Map. (Accessed Aug. 2024).

Member of the Physical Therapy Compact

SOURCE: Compact Map. Physical Therapy Compact. (Accessed Aug. 2024).

Member of the Psychology Interjurisdictional Compact (PSYPACT)

SOURCE: PSYPACT Map. (Accessed Aug. 2024).

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

Last updated 08/26/2024

Miscellaneous

A licensee who provides health care via telehealth:

  1. may only provide health care within his scope of practice;
  2.  shall adhere to the same standard of care as required for in-person care and must be evaluated according to the standard of care applicable to the licensee’s area of specialty. The failure of a licensee to conform to the appropriate standard of care is considered unprofessional conduct and may be disciplined according to the licensee’s respective practice act and pursuant to Section 40-42-10(3);
  3. shall generate and maintain confidentiality of a patient’s records and disclose the records to the patient consistent with state and federal laws, rules, and regulations; provided, that licensees practicing telemedicine must 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 by traditional means;

A licensee or any other person involved in a telehealth encounter must:

  •            be trained in the use and operation of the telehealth equipment; and
  •            demonstrate competence in the use and operation of telehealth equipment.

Notwithstanding any of the provision of this section, a licensee’s respective licensing board retains all authority with respect to telehealth practice in accordance with the authorization provided to him by his respective practice act.

SOURCE: SC Code Annotated Sec. 40-42-20 as proposed to be added by H 4159 (2024 Session). (Accessed Aug. 2024).

A licensee who provides care, renders a diagnosis, or otherwise engages in the practice of medicine as defined in Section 40-47-20(36) via telemedicine as defined in Section 40-47-20(52) shall:

  • adhere to the same standard of care as in-person medical care and be evaluated according to the standard of care applicable to the licensee’s area of specialty. The failure of a licensee to conform to the appropriate standard of care is considered unprofessional conduct under Section 40-47-110(B)(9);
  • generate and maintain medical records for such telemedicine services in compliance with any applicable state and federal laws, rules, and regulations including this chapter, the Health Insurance Portability and Accountability Act (HIPAA), and the Health Information Technology for Economic and Clinical Health Act (HITECH). Such records timely must be made accessible to other practitioners and to the patient when lawfully requested by the patient or his lawfully designated representative;

In addition to those requirements set forth in subsection (A), a licensee who establishes and/or maintains a physician-patient relationship, provides care, renders a diagnosis, or otherwise engages in the practice of medicine as defined in Section 40-47-20(36) solely via telemedicine as defined in Section 40-47-20(53) shall:

  1. adhere to current standards for practice improvement and monitoring of outcomes and provide reports containing such information upon request of the board;
  2. provide an appropriate evaluation prior to diagnosing and/or treating the patient, which need not be done in person if the licensee considers that he is able to accurately diagnose and treat the patient in conformity with the applicable standard of care via telehealth; provided that evaluations in which a licensee is at a distant site, but a practitioner who is acting within his scope is able to provide various physical findings the licensee needs to complete an adequate assessment, is permitted
  3. ensure the availability of appropriate follow-up care;
  4. verify the identity and location of the patient and inform the patient of the licensee’s name, location, and professional credentials;
  5. maintain the confidentiality of a patient’s records and disclose the records to the patient consistent with state and federal law; provided, that licensees practicing telemedicine must 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;
  6. if applicable, 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.

Notwithstanding any of the provisions of this section, the board shall retain all authority with respect to telemedicine practice as granted in Section 40-47-10(I) of this chapter.

SOURCE: SC Code Annotated Sec. 40-47-37 as amended by H 4159 (2024 Session). (Accessed Aug. 2024).

Physician assistants are authorized to perform telemedicine and telehealth in accordance with the requirements of Section 40-47-37 including, but not limited to, Section 40-47-37(C)(6) requiring board authorization prior to prescribing Schedule II and Schedule III prescriptions; Section 40-47-113, approved written scope of practice guidelines, and pursuant to all physician supervisory requirements imposed by this chapter without having to be licensed to practice medicine in this State as otherwise required in Section 40-47-37(A)(4).

SOURCE: SC Code Annotated Sec. 40-47-935 as amended by H 4159 (2024 Session). (Accessed Aug. 2024).

An APRN may perform medical acts via telemedicine and telehealth pursuant to a practice agreement as defined in Section 40-33-20(45) without having to be licensed to practice medicine in this State as otherwise required in Section 40-47-37(A)(4).

SOURCE: SC Code Annotated Sec. 40-33-34(I)(2) as amended by H 4159 (2024 Session). (Accessed Aug. 2024).

Specific tasks may be delegated to a certified medical assistant (CMA) by a physician, physician assistant if authorized to do so in his scope of practice guidelines, or advanced practice registered nurse if authorized to do so in his practice agreement. The scope of practice guidelines for a physician assistant and the practice agreement for an advanced practice registered nurse must address what tasks may be appropriately delegated to a CMA, provided, however, that certain tasks, including performing a clinical decision‑making task by means of telemedicine, must not be delegated to a CMA by a physician assistant or advanced practice registered nurse.

A physician or physician assistant, pursuant to the physician assistant’s scope of practice guidelines, may delegate nursing tasks to unlicensed assistive personnel (UAP) under the supervision of the physician or physician assistant. Such nursing tasks include, but are not limited to performing nonclinical tasks via telemedicine. Pursuant to an advanced practice registered nurse’s practice agreement, he may delegate nonclinical tasks via telemedicine to a UAP as well.

SOURCE: SC Code Annotated Sec. 40-47-196 as proposed to be amended by H 5183 (2024 Session). (Accessed Aug. 2024).

Probate – Procedure for court appointment of a guardian; report evaluating condition of alleged incapacitated individual. For purposes of this section of law, at the discretion of the court, the “examination” must be conducted in person or virtually via telemedicine or other appropriate methods.

SOURCE: SC Code Sec. 62-5-303D(C) as proposed to be added by H 4234 (2024 Session). (Accessed Aug. 2024).

Last updated 08/26/2024

Online Prescribing

A licensee who provides care, renders a diagnosis, or otherwise engages in the practice of medicine as defined in Section 40-47-20(36) via telemedicine as defined in Section 40-47-20(52) shall:

  1. adhere to the same standard of care as in-person medical care and be evaluated according to the standard of care applicable to the licensee’s area of specialty. The failure of a licensee to conform to the appropriate standard of care is considered unprofessional conduct under Section 40-47-110(B)(9);
  2. prescribe in accordance with Section 40-47-113;

In addition to those requirements set forth in subsection (A), a licensee who establishes and/or maintains a physician-patient relationship, provides care, renders a diagnosis, or otherwise engages in the practice of medicine as defined in Section 40-47-20(36) solely via telemedicine as defined in Section 40-47-20(53) shall:

  1. adhere to current standards for practice improvement and monitoring of outcomes and provide reports containing such information upon request of the board;
  2. provide an appropriate evaluation prior to diagnosing and/or treating the patient, which need not be done in person if the licensee considers that he is able to accurately diagnose and treat the patient in conformity with the applicable standard of care via telehealth; provided that evaluations in which a licensee is at a distant site, but a practitioner who is acting within his scope is able to provide various physical findings the licensee needs to complete an adequate assessment, is permitted;
  3. ensure the availability of appropriate follow-up care;
  4. verify the identity and location of the patient and inform the patient of the licensee’s name, location, and professional credentials;
  5. maintain the confidentiality of a patient’s records and disclose the records to the patient consistent with state and federal law; provided, that licensees practicing telemedicine must 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;
  6. if applicable, 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;
  7. be prohibited from establishing a physician-patient relationship pursuant to Section 40-47-113(B) for the purpose of prescribing medication when an in-person physical examination is necessary for diagnosis.
  8. prescribe in compliance with all relevant federal and state laws including, but not limited to, participation in the South Carolina Prescription Monitoring Program in Article 15, Chapter 53, Title 44 and the Ryan Haight Act, within a practice setting fully compliant with this section, and subject to the following limitations:
    • at each encounter, threshold information necessary to make an accurate diagnosis must be obtained in a medical history interview conducted by the prescribing licensee;
    • Schedule II-narcotic and Schedule III-narcotic prescriptions are not permitted except in the following instances:
      • when the practice of telemedicine is being conducted while the patient is physically located in a hospital and being treated by a practitioner acting in the usual course of professional practice;
      • those Schedule II and Schedule III medications used specifically for patients actively enrolled in a Medication-Assisted Treatment (MAT) program with a provider who has an established physician-patient relationship when buprenorphine is being prescribed as a medication for opioid use disorder;
      • patients enrolled in palliative care or hospice; or
      • any other programs specifically authorized by the board; and
    • prescribing abortion inducing drugs is not permitted; as used in this chapter “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. This includes off label use of drugs known to have abortion-inducing properties that are prescribed specifically with the intent of causing an abortion, such as misoprostol (Cytotec) and methotrexate. This definition does not apply to drugs that may be known to cause an abortion, but which are prescribed for other medical indications including, but not limited to, chemotherapeutic agents or diagnostic drugs. Use of such drugs to induce abortion is also known as “medical”, “drug induced”, or “chemical abortion”

Notwithstanding any of the provisions of this section, the board shall retain all authority with respect to telemedicine practice as granted in Section 40-47-10(I) of this chapter.

SOURCE: SC Code Annotated Sec. 40-47-37 as amended by H 4159 (2024 Session). (Accessed Aug. 2024).

A licensee who provides health care via telehealth shall, if authorized by the licensee’s respective practice act and within his scope of practice, prescribe in accordance with all applicable state and federal laws, including his respective practice act, rules and regulations, and standards required by such practice authorization; and shall maintain a controlled substances registration with South Carolina’s Bureau of Drug Control if prescribing controlled substances.

Nothing in this section may be construed to prohibit electronic communications between a licensee and patient with a preexisting licensee-patient relationship, between a licensee and another licensee concerning a patient with whom the other licensee has a licensee-patient relationship, or between a licensee and a patient when treatment is provided pursuant to an on-call situation or a cross-coverage situation.

In addition to the provisions of subsection (A), a licensee who establishes or maintains a licensee-patient relationship solely via telehealth shall:

  1. adhere to current standards for practice improvement and monitoring of outcomes and provide reports containing this information upon request of his respective licensing board;
  2. provide an appropriate evaluation before providing health care to the patient, which need not be done in person, if the licensee determines he is able to appropriately provide health care to the patient via telehealth in conformity with the same standard of care required for in-person care;
  3. ensure availability of appropriate follow-up care;
  4. verify the identity and location of the patient and inform the patient of the licensee’s name, location, and professional credentials; and
  5. only prescribe:
    • if specifically authorized by his respective practice act;
    • within his scope of practice; and
    •  in accordance with federal and state laws, rules, standards provided in the practice act and, if applicable, any practice agreement or scope of practice guidelines.

Notwithstanding any of the provision of this section, a licensee’s respective licensing board retains all authority with respect to telehealth practice in accordance with the authorization provided to him by his respective practice act.

SOURCE: SC Code Annotated Sec. 40-42-20 as proposed to be added by H 4159 (2024 Session). (Accessed Aug. 2024).

An advance practice registered nurse (APRN) may perform medical acts via telemedicine and telehealth pursuant to a practice agreement as defined in Section 40-33-20(45) without having to be licensed to practice medicine in this State as otherwise required in Section 40-47-37(A)(4).

An APRN who establishes a nurse-patient relationship solely by means of telemedicine shall adhere to the same standard of care as a licensee employing more traditional in-person medical care. Failure to conform to the appropriate standard of care is considered unprofessional conduct and may be subject to enforcement by the board.

An APRN may not establish a nurse-patient relationship by means of telemedicine for the purpose of prescribing medication when an in-person physical examination is necessary for diagnosis.

An APRN who establishes a nurse-patient relationship solely by means of telemedicine only may prescribe within a practice setting fully in compliance with this chapter and during an encounter in which threshold information necessary to make an accurate diagnosis is obtained in a medical history interview conducted by the prescribing licensee; provided, however, that Schedule II through V prescriptions are only permitted pursuant to a practice agreement as defined in Section 40-33-20(45) and nothing in this item may be construed to authorize the prescribing of medications via telemedicine that otherwise are restricted by the limitations in Section 40-47-37(C)(6) unless approved by a joint committee of the Board of Medical Examiners and the Board of Nursing.

An APRN who establishes a nurse-patient relationship solely by means of telemedicine shall generate and maintain medical records for each patient using those telemedicine services in compliance with any applicable state and federal laws, rules, and regulations, including the provisions of this chapter, the Health Insurance Portability and Accountability Act (HIPAA), and the Health Information Technology for Economic and Clinical Health Act (HITECH). These records must be accessible to other practitioners and to the patient in a timely fashion when lawfully requested by the patient or his lawfully designated representative.

SOURCE: SC Code Annotated Sec. 40-33-34(I) as amended by H 4159 (2024 Session). (Accessed Aug. 2024).

Physician assistants are authorized to perform telemedicine and telehealth in accordance with the requirements of Section 40-47-37 including, but not limited to, Section 40-47-37(C)(6) requiring board authorization prior to prescribing Schedule II and Schedule III prescriptions; Section 40-47-113, approved written scope of practice guidelines, and pursuant to all physician supervisory requirements imposed by this chapter without having to be licensed to practice medicine in this State as otherwise required in Section 40-47-37(A)(4).

SOURCE: SC Code Annotated Sec. 40-47-935 as amended by H 4159 (2024 Session). (Accessed Aug. 2024).

Last updated 08/26/2024

Professional Board Standards

South Carolina Board of Examiners in Psychology*

SOURCE: Telehealth Statement, March 11, 2019. (Accessed Aug. 2024).

South Carolina Board of Physical Therapy Examiners*

SOURCE: Advisory Opinion On The Use Of Telehealth, Oct. 28, 2020. (Accessed Aug. 2024).

South Carolina Board of Occupational Therapy*

SOURCE: Advisory Opinion On The Use Of Telehealth, June 12, 2020 (Accessed Aug. 2024).

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

SOURCE: Policy Regarding Telepractice, 2022. (Accessed Aug. 2024).

 

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