Updates to the Durable Medical Equipment 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 Durable Medical Equipment (DME) Services Manual and DME Fee Schedule. These updates align policy with industry standards and will enhance operational consistency, reduce billing confusion and strengthen the agency's strategy to support program integrity and reinforce fraud, waste and abuse controls. These updated documents:

• Clarify covered services and their corresponding clinical criteria;
• Update documentation requirements for medical necessity;
• Specify when and what items require a face-to-face encounter;
• Provide updated billing guidance; and
• Specify the units, frequencies and authorization requirements for each procedure code.

A draft of the DME Services Manual is available here, and a draft of the DME Fee Schedule is available here.

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

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

SCDHHS will conduct two live webinars to provide guidance on both the draft and final 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 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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