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Physician Services Provider Manual Updates
Effective date
Sep 1, 2025
Identified
Jun 18, 2026
Summary
South Carolina Medicaid is requiring prior authorization for three SMA genetic testing codes (81329, 81336, 81337) starting September 1, 2025, while eliminating prior authorization requirements for circumcision procedures (54161) for patients older than 28 days. Providers must maintain medical necessity documentation for circumcisions in patient records.
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What to do
Action · 3 steps
01Before September 1, 2025: Billing team must update system to require prior authorization for CPT codes 81329, 81336, and 81337 for SMA genetic testing.
02Remove prior authorization requirements for CPT 54161 circumcisions but ensure providers document medical necessity in patient records.
03Update encounter forms and billing workflows for South Carolina Medicaid patients.
Codes mentioned
81329813368133754161
Original notice
Physician Services Provider Manual Updates
scdhhs.gov · Always check the source before changing claims.