HCBS Waivers Fee Schedule
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State Medicaid HCBS waivers fee schedule listing procedure codes, modifiers, rates, billing increments, and program-specific caps effective November 1, 2025; affects providers billing South Carolina DHHS for HCBS waiver services.
No material clinical or coverage changes in this revision.
Coverage and Reimbursement Criteria
Selected service coverage entries
Representative coverage entries from the schedule (partial document):
Fee schedule reimbursement criteria
Provider reimbursement criteria from schedule entries (codes, modifiers, rates, billing units, caps/frequency where listed):
Procedure Codes, Modifiers, Rates and Limits
Provider Requirements, Prior Approval, and Billing Notes
Prior approval required for specialized equipment
Specialized Medical Equipment and Assistive Technology requires prior approval and is billed per claim under code T2029; use “As Approved” for pricing determinations.
- Procedure code: T2029
- Pricing: As Approved
- Billing increment: Per claim
Modifications are cap-limited and subject to plan-year limits
Environmental Modifications and Private Vehicle Modifications are subject to specified cap limits and plan-year caps; Environmental Modifications are listed as a cap limit and billed per plan year.
- Environmental Modifications (S5165): Rate = Cap Limit; billing = Per plan year
- Private Vehicle Modification: subject to cap limits (see vehicle-specific entry)
HASCI equipment assessment requires U1 and reimbursed $300
For the HASCI program, the Specialized Medical Equipment and Assistive Technology Assessment/Consultation (T2029) requires modifier U1 and is reimbursed at $300.00 per item.
- Procedure code: T2029
- Modifier required: U1
- Rate: $300.00 per item
Program and Billing Definitions
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