South Carolina Billing Guide for Mental Health Therapists and Psychiatrists
Who pays, where to enroll and which rules change your claims in South Carolina, for psychotherapists and psychiatric prescribers.
Last checked October 25, 2026. Reviewed against the official sources listed at the bottom of this page.
This South Carolina billing guide covers Medicaid, Medicare, Blue Cross, other private payers and state law for therapists and psychiatrists, with sources and a last-checked date.
South Carolina billing guide: how South Carolina pays for outpatient care
The South Carolina Department of Health and Human Services (SCDHHS) runs Healthy Connections, the state Medicaid program. SCDHHS's managed care page lists five Medicaid MCOs (Absolute Total Care, Healthy Blue by BlueChoice, Humana Healthy Horizons, Molina, and First Choice by Select Health); SCDHHS also says it oversees licensed independent practitioner (LIP) behavioral health services through both fee-for-service and MCOs.
Medicaid claims must be entered within one year of the date of service (SCDHHS bulletin and Provider Administrative and Billing Manual, revised 7/1/2026), with longer limits for Medicare cost-sharing and retroactive eligibility claims. The Blue plan is BlueCross BlueShield of South Carolina, an independent licensee, with BlueChoice HealthPlan as its managed care subsidiary. Medicare Part B is handled by Palmetto GBA in Jurisdiction M. SC's Palmetto Pathways work-requirement waiver was submitted to CMS on 6/23/2025; SCDHHS's page does not state approval or address the federal 1/1/2027 requirement.
Who to bill, at a glance
| Payer type | Who you bill | Where to enroll or check rules |
|---|---|---|
| Medicaid | South Carolina Healthy Connections Medicaid (SCDHHS); managed care through MCOs plus fee-for-service: South Carolina Department of Health and Human Services (SCDHHS) | Provider enrollment |
| Medicare Part B | Palmetto GBA, LLC | CMS MAC page |
| Blue Cross Blue Shield | BlueCross BlueShield of South Carolina (BCBSSC) | See the Blue Cross section below |
South Carolina Medicaid and how to bill it
This South Carolina billing guide starts with Medicaid, because it decides who pays and how you file.
Mixed. SCDHHS lists five MCO partners (Absolute Total Care, BlueChoice/Healthy Blue, Humana Healthy Horizons, Molina, Select Health/First Choice) and a sixth entry, Medical Home Network: South Carolina Solutions, on its health plan contact table. SCDHHS's LIP training (July 2026) says it oversees these services through both fee-for-service and MCO programs.
SCDHHS's final public notice (dated March 31, 2016, effective on or after July 1, 2016) carried rehabilitative behavioral health services (RBHS) and associated outpatient services into MCO coverage under the coordinated care benefit.
| Item | What to know |
|---|---|
| Agency | South Carolina Department of Health and Human Services (SCDHHS) |
| Claims or fiscal agent | SCDHHS Provider Service Center and the Healthy Connections Medicaid Web-based Claims Submission Tool (Web Tool; requires a Trading Partner Agreement; accepts CMS-1500 and UB-04). Provider Service Center (888) 289-0709. |
| Provider enrollment | Official enrollment page |
| Manual or fee schedule | Official manual or fee schedule |
| Provider portal | Provider portal |
| Work requirement | SCDHHS's Palmetto Pathways to Independence page says the community engagement waiver (adults 19-64 meeting parent caretaker criteria, income 67% to 100% FPL, 80 hours a month) was submitted to CMS on June 23, 2025, and does not state whether CMS approved it. The page does not mention H.R. 1 or January 1, 2027. The waiver application states it is not Medicaid expansion. |
Managed-care plans and carve-outs
| Plan or entity | Role in behavioral health |
|---|---|
| Absolute Total Care | Listed on SCDHHS health plan contact table. |
| Healthy Blue by Blue Choice of SC | Medicaid plan in the BlueChoice family (BlueCross BlueShield of South Carolina About Us page). |
| Molina Healthcare of South Carolina | Provider Services (855) 237-6178 per Molina SC provider handbook (Last Updated 4/2025). |
| First Choice by Select Health | Provider Enrollment/Credentialing (800) 741-6605; Prior Authorization (888) 559-1010 per SCDHHS table. |
| Humana Healthy Horizons in South Carolina | Provider Services 866-432-0001 (Mon-Fri 8 a.m.-6 p.m. Eastern). |
| Medical Home Network: South Carolina Solutions | Appears on the SCDHHS contact table with a business office (803) 753-1109 and member services (888) 366-6243. |
Medicare cost-sharing claims: two years from date of service or six months after the Medicare payment date, whichever is later. Retroactive eligibility claims: entered within six months of eligibility being added and within three years of the date of service, with DHHS Form 945 or the eligibility approval letter.
Medicare Part B in South Carolina
For Medicare, this South Carolina billing guide names your contractor and the current telehealth rules.
As of 2026-10-25, per CMS Telehealth FAQ (updated 10/8/26): Medicare telehealth services remain available nationwide through the end of 2027, including audio-only in the home through December 31, 2027.
| Item | What to know |
|---|---|
| Contractor | Palmetto GBA, LLC |
| Jurisdiction | Jurisdiction M (JM): North Carolina, South Carolina, Virginia and West Virginia (Part B excludes Arlington and Fairfax counties and the city of Alexandria in Virginia). |
| Source | CMS.gov MAC page |
Blue Cross Blue Shield in South Carolina
This part of the South Carolina billing guide names the exact Blue Cross licensee, because Blue plans never share rules.
Blue Cross Blue Shield is a federation of independent companies, so one licensee's rules never apply to another. Here is who holds the Blue license in South Carolina.
| Licensee | Parent or affiliation | Where it applies | Provider resources |
|---|---|---|---|
| BlueCross BlueShield of South Carolina (BCBSSC) | Its About Us page describes BlueCross BlueShield of South Carolina as the company with a family of companies including BlueChoice HealthPlan of South Carolina (managed care subsidiary) and Healthy Blue (Medicaid plan). | South Carolina. | Source |
Other private payers and EAPs in South Carolina
The South Carolina billing guide also covers commercial plans and employee assistance programs.
These commercial payers and plan families most often matter for behavioral health billing in South Carolina. Check each payer's current provider manual before you submit.
| Payer | Behavioral health note | Provider resources |
|---|---|---|
| Ambetter from Absolute Total Care (marketplace) | Ambetter SC Provider Quick Reference Guide (cover dated January 2026): timely filing 180 days from date of service; payer ID 68069; Provider Services 1-833-270-5443. | Official page |
| Aetna | Provider contact page lists one number for indemnity and PPO-based plans; not SC-specific. | Official page |
| Cigna / Evernorth Behavioral Health | Cigna provider contact page lists Evernorth Behavioral Health at 800.926.2273; not SC-specific. | Official page |
| UnitedHealthcare / Optum Behavioral Health | UHC provider contact page lists behavioral health 877-614-0484 and general provider assistance 877-842-3210; not SC-specific. | Official page |
South Carolina billing guide: state law that changes billing
Use this section of the South Carolina billing guide to separate state law from payer policy.
State law sets the floor for commercial plans in South Carolina. Medicare and Medicaid rules are covered in their own sections above.
Prompt payment and timely filing
Commercial prompt pay (archived 2015 copy of the Code of Laws on scstatehouse.gov): an insurer must direct payment of a clean claim within 20 business days if submitted electronically or 40 business days if submitted on paper. Source
Practitioner scope: therapists and prescribers
Medicaid: SCDHHS's LIP manual covers individually enrolled licensed independent practitioners (psychotherapy, assessments, crisis intervention); supervisees without independent licensure must be under board-approved supervision with the supervisor at the same location and immediately accessible. Source
Not legal advice. Confirm statute details with counsel.
South Carolina billing guide: codes and rates
This South Carolina billing guide lists only codes and rates confirmed on official pages.
These are the South Carolina-specific codes, modifiers and rate items confirmed on official pages.
| Code or item | What to know |
|---|---|
| RBHS/LIP core psychotherapy rate increase (7/1/2024) | SCDHHS bulletin lists procedure codes 90791, 90832, 90834, 90837, 90846, 90847, 90853, H0031, H0032 (RBHS providers only) and H2011. Source |
| Telehealth modifier (Humana Healthy Horizons SC) | Humana's SC Medicaid behavioral health guidance says telehealth services are billed with the GT modifier. Source |
| Humana Healthy Horizons behavioral health authorization | Guidance says authorization is required after 24 visits; most outpatient behavioral health services are reimbursed without prior authorization per the 2025 provider manual (Chapter 5). Source |
South Carolina billing guide: what changed, newest first
Check this South Carolina billing guide update log before you rely on an older rule.
| Date | What changed | Source |
|---|---|---|
| 2026-10-08 | CMS Telehealth FAQ updated: Medicare telehealth flexibilities through the end of 2027; in-person requirement for mental health telehealth applies after that, with an exception for patients who started at home on or before 12/31/2027. | Source |
| 2026-07-09 | SCDHHS LIP provider training update: group practice link requests need a notarized individual request, group practice requests not accepted after July 1; prior authorization tied to the individual provider. | Source |
| 2026-07-02 | SCDHHS announced updated RBHS and LIP provider manuals (Medicaid bulletin MB# 26-023), effective July 1, 2026, with new ORP requirements for psychiatrists and physicians in RBHS organizations and updated LIP business requirements. | Source |
| 2026-07-01 | SCDHHS Provider Administrative and Billing Manual revised July 1, 2026; Medicaid claim filing limit remains one year from date of service. | Source |
| 2026-05-04 | Draft RBHS and LIP manuals released for comment in Medicaid bulletin MB# 26-012. | Source |
| 2024-07-01 | RBHS/LIP core psychotherapy rate increase took effect for listed codes (90791, 90832, 90834, 90837, 90846, 90847, 90853, H0031, H0032, H2011). | Source |
How do I bill mental health claims in South Carolina?
These answers come from the same sources as the rest of this South Carolina billing guide.
The South Carolina Department of Health and Human Services (SCDHHS) runs Healthy Connections, the state Medicaid program. SCDHHS's managed care page lists five Medicaid MCOs (Absolute Total Care, Healthy Blue by BlueChoice, Humana Healthy Horizons, Molina, and First Choice by Select Health); SCDHHS also says it oversees licensed independent practitioner (LIP) behavioral health services through both fee-for-service and MCOs. Start with the member's payer type: Medicaid plan, Medicare Part B, a Blue Cross licensee or another commercial plan.
Questions about billing in South Carolina
How long do I have to bill South Carolina Medicaid claims?
Medicare cost-sharing claims get two years from the date of service or six months after the Medicare payment, whichever is later. Retroactive eligibility claims must be entered within six months of eligibility being added and within three years of service.
Who manages Medicaid behavioral health claims in South Carolina?
SCDHHS lists five Medicaid MCOs: Absolute Total Care, Healthy Blue by BlueChoice, Humana Healthy Horizons, Molina and First Choice by Select Health. SCDHHS says it oversees licensed independent practitioner services through both fee-for-service and MCOs, and for MCO members the MCO handles authorization, coverage and reimbursement. Check each member's plan before billing.
Which Blue Cross plan is South Carolina's?
BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross Blue Shield Association, and BlueChoice HealthPlan is its managed care subsidiary (also an independent licensee, per its About Us page). Its behavioral health benefits are managed by Companion Benefit Alternatives, a separate company. Do not apply another state's Blue plan rules.
Who processes Medicare Part B claims in South Carolina?
Palmetto GBA is the Medicare Administrative Contractor for Jurisdiction M, which includes North Carolina, South Carolina, Virginia and West Virginia. Per the CMS Telehealth FAQ updated 10/8/26, Medicare telehealth flexibilities, including audio-only at home, run through 2027. The mental health in-person visit requirement applies after that.
Does MCM South bill for practices in South Carolina?
MCM South currently serves ten states; request a quote to ask about South Carolina.
Sources for the South Carolina billing guide
Last checked October 25, 2026. Every source below was opened and read on that date.
- SCDHHS Provider Administrative and Billing Manual (rev. 7/1/2026), checked October 25, 2026
- SCDHHS Medicaid bulletin: Time Limit for Submitting Claims (11/24/2009), checked October 25, 2026
- SCDHHS health plan contact information, checked October 25, 2026
- SCDHHS: What is a Managed Care Organization?, checked October 25, 2026
- SCDHHS provider enrollment information, checked October 25, 2026
- SCDHHS LIP Provider Training (July 2026), checked October 25, 2026
- SCDHHS updated RBHS and LIP provider manuals (MB# 26-023), checked October 25, 2026
- SCDHHS RBHS/LIP rate increase bulletin (6/14/2024), checked October 25, 2026
- SCDHHS final public notice RBHS carve-in (3/31/2016), checked October 25, 2026
- SCDHHS Palmetto Pathways to Independence waiver page, checked October 25, 2026
- Medicaid.gov Palmetto Pathways waiver application (6/23/2025), checked October 25, 2026
- CMS MAC Jurisdiction M (JM) page, checked October 25, 2026
- CMS Telehealth FAQ (updated 10/8/26), checked October 25, 2026
Related guides
- State & Regional Billing Guides hub
- In-network vs out-of-network credentialing
- Credentialing and network status
- Mental health parity explained
- Medicaid managed care billing
- Medicare behavioral health billing
- Timely filing in the billing glossary
- Who we serve
- Georgia insurance companies contact guide
- Texas insurance companies contact guide
- Florida insurance companies contact guide
- Tennessee insurance companies contact guide
Billing in South Carolina? Let us handle the payer calls.
MCM South bills only mental and behavioral health, for psychotherapists and psychiatrists, in solo and medium-size practices. We currently serve ten states; request a quote to ask about South Carolina.
MCM South currently serves practices in ten states: Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois.