Updates to Clinic Services Manual

Effective for dates of service on or after Dec. 1, 2026, the South Carolina Department of Health and Human Services (SCDHHS) will update the Clinic Services Manual. These updates will clarify service definitions, clinical criteria and billing guidelines. This updated manual includes the following key changes:

• Provides additional information for opioid treatment programs;
• Adds updated billing guidance for dental services delivered in ambulatory surgical centers;
• Incorporates updated billing and reimbursement guidance for End-Stage Renal Disease clinics;
• Adds definitions for types and settings of dialysis services; and
• Clarifies policy for in-home dialysis services.

A draft of the updated Clinic Services Manual is available for review here.

Providers are encouraged to submit feedback about the draft manual by emailing [email protected] by Nov. 2, 2026.

The updated manual will go into effect and be posted on the Provider Manual page of SCDHHS' webite by Dec. 1, 2026.

SCDHHS will conduct two live webinars to provide guidance on the manual updates. Each webinar will be recorded for future viewing and will be available after the live webinars on the Provider Training Resources page of the SCDHHS website. Dates, times and registration links for the live webinars are as follows:

Anti-kickback Policy
SCDHHS is reminding providers of its anti-kickback policy published in the Provider Administrative and Billing Manual to ensure compliance with state and federal laws.

The South Carolina Healthy Connections Medicaid program strictly prohibits all forms of provider kickbacks and self-referrals as outlined in S.C. Code § 44-113-60 and 42 USC § 1320a-7b(b). Violations of either statute may result in administrative, civil and/or criminal penalties, up to and including program termination and referral to law enforcement authorities.

South Carolina's Medicaid managed care organizations (MCOs) are responsible for the authorizations, coverage and reimbursement related to the services described in this bulletin for members enrolled in an MCO.

Providers may direct questions about this bulletin to the Provider Service Center (PSC). PSC representatives can be reached at (888) 289-0709 from 7:30 a.m.-5 p.m. Monday-Thursday and 8:30 a.m.-5 p.m. Friday. Providers may also submit an online inquiry at https://www.scdhhs.gov/providers/contact-provider-representative.

Thank you for your continued support of the South Carolina Healthy Connections Medicaid program.

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