SC Medicaid Behavioral Health Claims and Telehealth Billing

Last updated: October 9, 2026.

For South Carolina Medicaid behavioral health billing, first confirm the receiving payer for the member, service and date. FFS claims and Healthy Connections MCO claims follow different submission routes. Start with the current Provider Administrative and Billing Manual and LIP manual entry point, checked October 9, 2026.

Choose FFS or the member’s MCO

Complete eligibility verification before selecting the claim destination. The administrative manual describes the state Web Tool for professional claims and separate MCO filing requirements. State enrollment alone does not determine where every member’s claim belongs.

For MCO members, the state’s telehealth bulletin makes the plan responsible for authorization, coverage and reimbursement of the described services. Use the plan’s current submission and authorization guidance. Our MCO and FFS credentialing guide links the official current plan list.

Prepare the professional claim

The LIP manual, billing section, specifies CMS-1500 billing and identifies AH for clinical psychologists and HO for master’s-degree-level providers. Check the procedure’s requirements, provider record and group relationship before filing; a modifier does not establish enrollment or medical necessity.

For FFS electronic submission, use the administrative manual’s Web Tool or EDI instructions and the applicable companion guide. Resolve TPA and biller access before expecting a vendor to submit or retrieve remittances for the practice.

For a plan claim, use that plan’s route. Absolute Total Care’s electronic transaction page, for example, offers portal claims submission and distinguishes medical and behavioral health routing in its clearinghouse table. Confirm the payer entry with your clearinghouse rather than copying an identifier from another plan or product.

Covered video services and the GT modifier

SCDHHS’s permanent telehealth bulletin includes behavioral health codes 90791, 90832, 90834, 90837, 90846 and 90847. Coverage still depends on the service requirements and applicable benefit limits. The bulletin requires GT for telehealth procedures after other required modifiers.

The July 2026 LIP manual describes synchronous audio/video as the reimbursed default unless otherwise specified. It places GT in the secondary position when the primary modifier identifies professional credentials. Read the current procedure entry and the receiving payer’s instructions together before building a claim template.

Do not guess audio-only coverage or place of service

A phone call should not automatically be billed as video psychotherapy. The state bulletin separates its audio-only E/M provisions from the behavioral health code list and ended the listed nonphysician telephonic assessment flexibilities January 1, 2025. Check explicit coverage for the actual service and provider before billing a phone-only encounter.

Confirm the appropriate place-of-service value with the receiving payer. The current LIP billing section lists common service locations, but it does not establish a blanket instruction to use POS 02 or 10 for every remote LIP claim. Avoid importing a Medicare or another state’s template without SC-specific confirmation.

Check authorization and follow the claim response

Use the actual MCO’s current behavioral health resources when authorization is relevant. Absolute Total Care’s behavioral health page, for example, provides its plan-specific authorization and portal instructions. Those rules should not be generalized to other MCOs or FFS services.

After submission, retain the acceptance information and review the payer’s status or remittance response. Compare any failed claim with the coverage date, receiving payer, provider relationship, procedure and telehealth fields before making a correction. Use the receiving payer’s correction process and avoid sending an unchanged claim repeatedly.

If the problem is the provider record, return to LIP enrollment and group linkage. If the account cannot reach the record or remittance, return to Web Tool access.

Frequently Asked Questions

What modifier does SC Medicaid use for covered video therapy?

The state’s telehealth bulletin requires GT after other required modifiers. The LIP manual places GT second when the primary modifier signifies professional credentials.

Does the video therapy code list mean phone-only psychotherapy is covered?

No. Check explicit modality coverage for the service and provider. The state bulletin treats audio-only provisions separately and ended the listed nonphysician telephonic assessment flexibilities in 2025.

Do I automatically use POS 02 or 10 for every SC Medicaid remote LIP claim?

Do not assume a universal value. Confirm the service-specific place of service with the receiving payer and current SC guidance before filing.