Policy Clarifications and Reminders Related to End of COVID-19 Federal PHE
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Governance of which COVID-19-era Medicaid policy flexibilities continue, expire, or are extended following the end of the federal public health emergency; affects South Carolina Medicaid providers and members.
No material clinical or coverage changes in this revision.
Coverage Continuations and Operational Restarts
COVID-19 coverage continuation
COVID-19 vaccination and treatment coverage post-PHE:
ALL of the following
- COVID-19 vaccine administration is covered without cost sharing for all eligibility groups (includes full-benefit Medicaid members and individuals enrolled in limited benefit programs, including the family planning limited benefit program)
Coverage continues through Sept. 30, 2024
- COVID-19 treatment (including specialized equipment and therapies) is covered without cost sharing for full-benefit Medicaid members
Covered without amount, duration, or scope limitations for COVID-19 treatment purposes; coverage continues through Sept. 30, 2024
EXCEPTION
- Covered for testing, vaccinations, and treatment only through the last day of the federal COVID-19 public health emergency (May 11, 2023)
ALL of the following
- Providers with questions about PHE-era policy flexibilities should submit questions to COVID@scdhhs.gov
ALL of the following
- COVID-19 vaccine administration and COVID-19 treatment coverage without cost sharing for applicable populations through Sept. 30, 2024
- Optional COVID-19 testing group coverage ends on the last day of the federal PHE (May 11, 2023)
ALL of the following
- See SCDHHS bulletin clarifications on continued coverage of COVID-19 treatment and vaccination
Operational restarts
Operational restarts and timelines:
ALL of the following
- SCDHHS will restart the revalidation process for Medicaid providers in the second half of calendar year 2023
Additional information and a more precise timeline will be provided in a future Medicaid bulletin
ALL of the following
- SCDHHS will resume standard annual eligibility reviews beginning April 2023 and will review groups of cases each month over a 12-month period (April 2023 through March 2024)
Some members may not receive notice or annual review form until March 2024; resources available at www.scdhhs.gov/annualreviews and providers can email AnnualReviews@scdhhs.gov for presentations
ALL of the following
- Provider communications and additional timelines will be issued via future bulletins and SCDHHS websites/toolkits
Telehealth Coding and Modifiers
| No codes listed |
Provider Billing Requirements and Actions
Bill telehealth with GT modifier for FQHCs/RHCs
When billing for any telehealth procedure code, submit claims with the GT modifier; if other billing modifiers are required, list GT after those modifiers. Telehealth services for FQHCs and RHCs are reimbursed as a bill‑above service and paid outside the encounter rate using the SCDHHS fee schedule.
- Submit GT modifier on all telehealth procedure code claims.
- If other modifiers are required, list GT after them.
- Telehealth is reimbursed as a bill‑above service and paid outside the FQHC/RHC encounter rate using the SCDHHS fee schedule.
Key Terms and Optional Groups
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