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SC Medicaid - SCDHHSMedicaid · Coverage · Provider Communication · SC · Psychiatry, PediatricsMedium impact

Addition of Intercept for Intensive In-home Services

Act
by Aug 1, 2026
Effective date
Aug 1, 2026
Identified
Aug 1, 2026

Summary

South Carolina Medicaid is adding coverage for Intercept, an evidence-based intensive in-home behavioral health service for at-risk youth ages up to 20, effective August 1, 2026. Providers must become licensed through Youth Villages and bill using new procedure code H0037-U2 with a bundled daily rate of $309.56 per diem, limited to 48 encounters over 120 days without prior authorization; additional encounters require prior authorization with medical necessity documentation.

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What to do

by Aug 1, 2026 · 5 steps
01Billing team must update billing system to recognize new procedure code H0037-U2 for Intercept services with $309.56 daily reimbursement rate and configure service limits (48 encounters maximum over 120 days, one per member per day).
02Update claim submission protocols to allow standard billing without prior authorization up to 48 encounters; configure system to flag claims exceeding 48 encounters for prior authorization requirement with attached medical necessity documentation via Medicaid webtool.
03Providers interested in delivering Intercept services must enroll as Healthy Connections Medicaid providers through SCDHHS and obtain Youth Villages licensure and training before service delivery.
04Review RBHS Provider Manual (updated by Aug 1, 2026) for complete enrollment and fidelity requirements.
05Billing team should contact Provider Service Center at (888) 289-0709 or MedicaidStatePlan@scdhhs.gov with enrollment or billing questions.
If missed: Failure to properly configure service limits and prior authorization thresholds will result in claim denials for services exceeding 48 encounters without required documentation.

Original notice

Addition of Intercept for Intensive In-home Services
scdhhs.gov · Always check the source before changing claims.
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Related policy hubs

SC Medicaid - SCDHHS policiesSC policy changesPsychiatryPediatrics

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