Who is affected by this change?

This affects BlueCross BlueShield of South Carolina in SC on Commercial, Exchange plans.

When does this change take effect?

This change is effective Aug 1, 2026.

What do I need to do?

Already effective August 1, 2026: For small group and individual plans, including Affordable Care Act (Marketplace) plans, with group number prefixes 61, 62, 64 and 65, submit prior authorization requests for the listed DME and home health HCPCS codes to IHCS. Providers are encouraged to submit through WellSky CarePort, CarePort Provider Portals, Availity Essentials or Parachute Health, using the guide titled Submit IHCS Referrals. If the facility does not use these platforms, contact IHCS to arrange an alternative submission method, or fax prescriptions, medical orders or discharge documentation to IHCS at 844-215-4265. Questions go to IHCS Provider Relations at 844-215-4264 or providerrelations@ihcscorp.com. IHCS offers educational webinars for providers and facilities, and registration is through IHCS@help.com. Check current applicability with IHCS before acting on this date.

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BlueCross BlueShield of South CarolinaCommercial · Prior Auth · Prior Authorization · SCHigh impact

Important Update – Prior Authorization for DME & Home Health Services

Effective date

Aug 1, 2026

Identified

Aug 13, 2026

Summary

Beginning August 1, 2026, IHCS supports prior authorizations for Durable Medical Equipment (DME) and Home Health services for BlueCross BlueShield of South Carolina small group and individual plans, including Affordable Care Act (Marketplace) plans. This applies to members with group number prefixes 61, 62, 64 and 65. Providers are encouraged to submit requests for the listed codes to IHCS through WellSky CarePort or CarePort Provider Portals, Availity Essentials, or Parachute Health.

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What to do

Action · 6 steps

01Already effective August 1, 2026: For small group and individual plans, including Affordable Care Act (Marketplace) plans, with group number prefixes 61, 62, 64 and 65, submit prior authorization requests for the listed DME and home health HCPCS codes to IHCS.

02Providers are encouraged to submit through WellSky CarePort, CarePort Provider Portals, Availity Essentials or Parachute Health, using the guide titled Submit IHCS Referrals.

03If the facility does not use these platforms, contact IHCS to arrange an alternative submission method, or fax prescriptions, medical orders or discharge documentation to IHCS at 844-215-4265.

04Questions go to IHCS Provider Relations at 844-215-4264 or providerrelations@ihcscorp.com.

05IHCS offers educational webinars for providers and facilities, and registration is through IHCS@help.com.

06Check current applicability with IHCS before acting on this date.

Codes mentioned

A4216A4217A4225A4230A4231A4232A4233A4235A4238A4239A4310A4311A4312A4313A4314A4315A4316A4320A4321A4322A4326A4327A4328A4330A4331A4332A4333A4334A4336A4338A4340A4344A4346A4349A4351A4352A4353A4354A4355A4356A4357A4358A4360A4361A4362A4363A4364A4366A4367A4368A4369A4371A4372A4373A4375A4376A4377A4378A4379A4380A4381A4382A4383A4384A4385A4387A4388A4389A4390A4391A4392A4393A4394A4395A4396A4397A4398A4399A4400A4402A4404A4405A4406A4407A4408A4409A4410A4411A4412A4413A4414A4415A4416A4417A4418A4419A4420A4421A4422A4423A4424A4425A4426A4427A4428A4429A4430A4431A4432A4433A4434A4435A4436A4437A4450A4452A4455A4456A4461A4463A4481A4483A4556A4557A4558A4559A4565A4595A4602A4604A4605A4606A4608A4611A4612A4614A4615A4616A4617A4618A4619A4620A4623A4624A4625A4626A4627A4628A4629A4630A4635A4636A4637A4639A4640A4930A5051A5052A5053A5054A5055A5056A5057A5061A5062A5063A5071A5072A5073A5081A5082A5083A5093A5102A5105A5112A5114A5120A5121A5122A5131A5200A6010A6011A6021A6022A6023A6024A6154A6196A6197A6198A6199A6203A6204A6206A6207A6208A6209A6210A6211A6212A6213A6214A6215A6216A6217A6218A6219A6220A6222A6223A6224A6229A6231A6232A6233A6234A6235A6236A6237A6238A6239A6240A6241A6242A6243A6244A6245A6246A6247A6248A6251A6252A6253A6254A6255A6257A6258A6259A6261A6266A6402A6403A6407A6410A6412A6441A6442A6443A6444A6445A6446A6447A6448A6449A6450A6451A6452A6453A6454A6455A6456A6457A6531A6545A6550A7000A7001A7002A7003A7004A7005A7006A7007A7008A7009A7010A7012A7013A7014A7015A7016A7017A7018A7020A7025A7026A7027A7028A7029A7030A7031A7032A7033A7034A7035A7036A7037A7038A7039A7040A7041A7044A7045A7046A7047A7048A7501A7502A7503A7504A7505A7506A7507A7508A7509A7520A7521A7522A7523A7524A7525A7526A7527A9272B4034B4035B4036B4081B4082B4083B4087B4088B4149B4150B4152B4153B4154B4155B9002E0100E0105E0110E0111E0112E0113E0114E0116E0117E0118E0130E0135E0140E0141E0143E0144E0147E0148E0149E0153E0154E0155E0156E0157E0158E0159E0160E0161E0162E0163E0165E0167E0168E0170E0171E0172E0175E0181E0182E0183E0184E0185E0186E0187E0188E0189E0191E0193E0194E0196E0197E0198E0199E0200E0202E0205E0210E0215E0217E0221E0225E0235E0236E0239E0240E0244E0245E0249E0250E0251E0255E0256E0260E0261E0265E0266E0271E0272E0273E0274E0275E0276E0277E0280E0290E0291E0292E0293E0294E0295E0296E0297E0300E0301E0302E0303E0304E0305E0310E0315E0316E0325E0326E0328E0329E0371E0372E0373E0424E0425E0430E0431E0433E0434E0435E0439E0440E0441E0442E0443E0444E0445E0446E0447E0455E0457E0459E0462E0465E0466E0467E0470E0471E0472E0480E0481E0482E0483E0484E0550E0555E0560E0561E0562E0565E0570E0572E0574E0575E0580E0585E0600E0601E0605E0607E0618E0619E0621E0627E0628E0629E0630E0635E0636E0637E0639E0640E0642E0650E0651E0652E0655E0656E0657E0659E0660E0665E0666E0667E0668E0669E0670E0671E0672E0673E0675E0676E0691E0705E0710E0720E0730E0731E0745E0747E0748E0760E0765E0776E0840E0849E0850E0855E0856E0860E0870E0880E0890E0900E0910E0911E0912E0920E0930E0935E0940E0941E0942E0944E0945E0946E0947E0948E0950E0951E0952E0953E0954E0955E0956E0957E0958E0959E0960E0961E0966E0967E0968E0969E0971E0973E0974E0978E0980E0981E0982E0983E0984E0985E0986E0988E0990E0992E0994E0995E1002E1003E1004E1005E1006E1007E1008E1010E1011E1012E1014E1015E1016E1017E1018E1020E1028E1029E1030E1031E1035E1036E1037E1038E1039E1050E1060E1070E1083E1084E1085E1086E1087E1088E1089E1090E1092E1093E1100E1110E1130E1140E1150E1160E1161E1170E1171E1172E1180E1190E1195E1200E1221E1222E1223E1224E1225E1226E1227E1228E1229E1230E1231E1232E1233E1234E1235E1236E1237E1238E1240E1270E1280E1285E1290E1295E1296E1297E1298E1310E1352E1353E1354E1355E1356E1357E1358E1372E1390E1391E1392E1399E1405E1406E1639E2000E2103E2201E2202E2203E2204E2205E2206E2207E2208E2209E2210E2211E2212E2213E2214E2215E2216E2217E2218E2219E2220E2221E2222E2224E2225E2226E2227E2228E2231E2300E2310E2311E2312E2313E2321E2322E2323E2324E2325E2328E2330E2340E2341E2342E2343E2359E2360E2361E2362E2363E2364E2365E2366E2367E2368E2369E2370E2371E2372E2373E2374E2375E2376E2377E2378E2381E2382E2383E2384E2385E2386E2387E2388E2389E2390E2391E2392E2394E2395E2396E2397E2402E2510E2601E2602E2603E2604E2605E2606E2607E2608E2611E2612E2613E2614E2615E2616E2619E2620E2621E2622E2623E2624E2625E2627E2631K0001K0002K0003K0004K0005K0006K0007K0008K0009K0010K0011K0012K0013K0015K0017K0018K0019K0020K0037K0038K0039K0040K0041K0042K0043K0044K0045K0046K0047K0050K0051K0052K0053K0056K0065K0069K0070K0071K0072K0073K0077K0098K0105K0108K0195K0455K0552K0601K0602K0603K0604K0605K0733K0738K0739K0740K0800K0801K0802K0806K0807K0808K0812K0813K0814K0815K0816K0820K0821K0822K0823K0824K0825K0826K0827K0828K0829K0830K0831K0835K0836K0837K0838K0839K0840K0841K0842K0843K0848K0849K0850K0851K0852K0853K0854K0855K0856K0857K0858K0859K0860K0861K0862K0863K0864K0868K0869K0870K0871K0877K0878K0879K0880K0884K0885K0886K0890K0891K0898L7900L8500L8501L8505S8185G0151G0152G0153G0155G0156G0157G0158G0159G0160G0161G0162G0299G0300G0493G0494G0495G0496G2168G2169S9122S9123S9124S9127S9128S9129S9131T1021T1030T1031

Original notice

Important Update – Prior Authorization for DME & Home Health Services

southcarolinablues.com · Always check the source before changing claims.

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2025 October Medical Policy UpdatesMediumEffective Oct 1, 2025 · Medical Policy Prior Authorization for DME and Home Health, Efftective Aug. 1, 2026HighEffective Aug 1, 2026 · Prior Authorization Browse every BlueCross BlueShield of South Carolina change in the policy list

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Important Update – Prior Authorization for DME & Home Health Services

Summary

Get alerts when payers change rules like this one

What to do

Codes mentioned

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