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SC Medicaid - SCDHHSMedicaid · Documentation · Medical Policy · SC · Physical Therapy, Occupational Therapy, Wound Care +2 moreHigh impact

Updates to the Durable Medical Equipment Services Manual

Act
by Nov 2, 2026
Effective date
Dec 1, 2026
Identified
Oct 6, 2026

Summary

South Carolina SCDHHS is updating its Durable Medical Equipment (DME) Services Manual and DME Fee Schedule, effective December 1, 2026. The updates will clarify covered services and clinical criteria, update documentation and medical necessity requirements, specify face-to-face encounter requirements, provide updated billing guidance, and define units, frequencies, and authorization requirements for procedure codes. Providers must review the draft manual and submit feedback by November 2, 2026, and attend training webinars on November 10 or December 3, 2026.

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What to do

by Nov 2, 2026 · 5 steps
01Billing team and clinical staff should review the draft DME Services Manual and DME Fee Schedule (available at source URL) and submit feedback to MedicaidStatePlan@scdhhs.gov regarding any concerns with covered services, clinical criteria, documentation requirements, face-to-face encounter specifications, billing guidance, or procedure code units and frequencies.
02By December 1, 2026: Billing team must update internal billing workflows, software configurations, and documentation templates to comply with the final DME Services Manual updates, including new clinical criteria, medical necessity documentation requirements, face-to-face encounter mandates, and authorization requirements for each DME procedure code.
03Recommended: Attend at least one live webinar (November 10, 2 p.m., or December 3, 10 a.m.) to receive training on manual updates; recorded sessions will be available on SCDHHS Provider Training Resources page.
04Contact PSC at (888) 289-0709 (Monday-Thursday 7:30 a.m.–5 p.m., Friday 8:30 a.m.–5 p.m.) or www.scdhhs.gov/providers/contact-provider-representative with questions.
05Note: South Carolina Medicaid MCOs are responsible for authorizations and coverage determinations for MCO-enrolled members; clarify member plan enrollment status when billing.

Original notice

Updates to the Durable Medical Equipment Services Manual
scdhhs.gov · Always check the source before changing claims.
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SC Medicaid - SCDHHS policiesSC policy changesPhysical TherapyOccupational TherapyWound CarePM&R (Physical Medicine & Rehab)General Practice

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