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SC Medicaid - SCDHHSMedicaid · Prior Auth · Medical Policy · SC · Psychiatry, PediatricsHigh impact

Updates to ASD Services Provider Manual

Act
by Jun 1, 2026
Effective date
Jul 1, 2026
Identified
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.

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What to do

by Jun 1, 2026 · 5 steps
01Review draft ASD Services Provider Manual and submit feedback to MedicaidStatePlan@scdhhs.gov.
02By July 1, 2026: Billing team must update system to require prior authorization for CPT 97155 (Direct Adaptive Behavior Treatment) when delivered via telehealth.
03Stop billing CPT 97151 (Behavior Identification Assessment) via telehealth entirely - only in-person delivery allowed.
04Update encounter forms and EMR templates to reflect new telehealth restrictions and prior auth requirements.
05Train providers on strengthened documentation requirements for plan of care and service delivery locations.

Codes mentioned

971569715597151

Original notice

Updates to ASD Services Provider Manual
scdhhs.gov · Always check the source before changing claims.
View original ↗

Related changes

See all SC Medicaid - SCDHHS changes →
Updates to ASD Services Provider ManualHighEffective Jul 1, 2026 · Medical PolicyBrowse every SC Medicaid - SCDHHS change in the policy list

Related policy hubs

SC Medicaid - SCDHHS policiesSC policy changesPsychiatryPediatricsCode 97156Code 97155Code 97151

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