South Carolina Telehealth State Laws & Reimbursement Policies

Medicaid Telehealth Reimbursement

Summary

South Carolina Medicaid reimburses for live video under certain circumstances. Store-and-forward is not reimbursed as it does not meet established conditions for the use of telemedicine. The South Carolina Medicaid reimburses for home health monitoring through the Home Aging Program for some conditions when a patient is eligible.

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Definitions

“Telemedicine is the use of medical information about a patient that is exchanged from one site to another via electronic communications to provide medical care to a patient in circumstances in which face-to-face contact is not necessary."

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Live Video

Policy
South Carolina Medicaid will reimburse for live video and covers telemedicine when the service is medically necessary and under certain circumstances.

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Eligible Services/Specialties
Click to view eligible services, including consultation, diagnostic and treatment services.

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Eligible Providers
Click to view eligible distant site providers.

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Eligible Sites
Geographic Limits
Distant (consultant) sites must be located in the SC Medical Service Area, which is the state of SC and areas in NC and GA within 25 miles of the SC border.

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Facility/Transmission Fee
The referring site is only eligible to receive a facility fee for telemedicine services. Claims are submitted with HCPCS code Q3014. If a provider performs separately identifiable service for a beneficiary on the same day as telemedicine, documentation of both services must be clearly and separately identified in the medical record and both services are eligible for reimbursement.

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Store-and-Forward

Policy
South Carolina Medicaid will not reimburse for store-and-forward due to the requirements that the beneficiary must be present and participating in the visit and interactive audio and video telecommunication must be used.

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Eligible Services/Specialties
Geographic Limits
Transmission Fee

Remote Patient Monitoring

Policy
Medicaid Home Again Program for Community Long Term Care: Medical telemonitoring will be of body weight, blood pressure, oxygen saturation, blood glucose levels, and basic heart rate information. Providers must meet certain conditions to participate.

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Conditions
Click to see qualifying conditions for Community Choices waiver participants.

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Provider Limitations
Click to see provider requirements.

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Other Restrictions
Click to view other criteria for participation for Community Choices waiver participants.

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Email/Phone/Fax

No reimbursement for email. No reimbursement for telephone. No reimbursement for FAX. No reimbursement for video cell phone interactions.

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Consent

A patient’s written consent is required prior to the dissemination of any of their images or information to other entities.

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Out of State Providers

Miscellaneous

If a beneficiary is a minor child, a parent and/or guardian must present the child for telemedicine services unless otherwise exempted by State or Federal law. The parent and/or guardian need not attend the telemedicine session unless attendance is therapeutically appropriate.

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Private Payer Laws

Definitions

Requirements

Parity

Professional Regulation/Health & Safety

Definitions

Telemedicine means the practice of medicine using electronic communications, information technology, or other means between a licensee in one location and a patient in another location with or without an intervening practitioner.

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Consent

Online Prescribing

A licensee shall not establish a physician-patient relationship by telemedicine for the purpose of prescribing medication when an in-person physical examination is necessary for diagnosis.
Schedule II and Schedule III prescriptions are not permitted except for those Schedule II and Schedule III medications specifically authorized by the board, which may include, but not be limited to, Schedule II-nonnarcotic and Schedule III-nonnarcotic medications.

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Cross State Licensing

The physician must be licensed in South Carolina; however, they do not need to reside in South Carolina.

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Miscellaneous

Click for a list of telehealth specific professional board regulations.

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Source: Center for Connected Health Policy
https://www.cchpca.org

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