MedicaidPrior AuthHigh impact
Updates to ASD Services Provider Manual
SC Medicaid - SCDHHS·SC · Psychiatry, Pediatrics·Medical Policy
Effective date
Jul 1, 2026
We identified it
Jun 18, 2026
Summary
South Carolina Medicaid is updating the Autism Spectrum Disorder (ASD) Services Provider Manual effective July 1, 2026, with significant changes to telehealth allowances, prior authorization requirements, and documentation standards. Key changes include permanent telehealth approval for CPT 97156, new prior auth requirements for CPT 97155, and elimination of telehealth for CPT 97151.
Action Required
By June 1, 2026: Review draft ASD Services Provider Manual and submit feedback to MedicaidStatePlan@scdhhs.gov. By July 1, 2026: Billing team must update system to require prior authorization for CPT 97155 (Direct Adaptive Behavior Treatment) when delivered via telehealth. Stop billing CPT 97151 (Behavior Identification Assessment) via telehealth entirely - only in-person delivery allowed. Update encounter forms and EMR templates to reflect new telehealth restrictions and prior auth requirements. Train providers on strengthened documentation requirements for plan of care and service delivery locations.