BlueCross BlueShield of South Carolina psychological testing coverage: codes, limits and prior authorization
The short answerBCBSSC authorizes psychological and neuropsychological testing (96116 to 96139) up front. The request needs a valid DSM or ICD-10 diagnosis and a licensed physician or psychologist; counselors are not authorized in South Carolina. Testing is limited to once per calendar year, and educational testing is excluded.
By Javier Alvarez · Updated · 1 min read
1 row: BlueCross BlueShield of South Carolina · South Carolina. Public policy, not the member's benefits.
BlueCross BlueShield of South Carolina
Medical policy CAM 397 Psychological and Neuropsychological Testing · South Carolina
| 96116 | Listed (in the policy scope; authorization process applies) [1] |
|---|---|
| 96121 | Listed (in the policy scope; authorization process applies) [1] |
| 96130 | Listed (in the policy scope; authorization process applies) [1] |
| 96131 | Listed (in the policy scope; authorization process applies) [1] |
| 96132 | Listed (in the policy scope; authorization process applies) [1] |
| 96133 | Listed (in the policy scope; authorization process applies) [1] |
| 96136 | Listed (in the policy scope; authorization process applies) [1] |
| 96137 | Listed (in the policy scope; authorization process applies) [1] |
| 96138 | Listed (in the policy scope; authorization process applies) [1] |
| 96139 | Listed (in the policy scope; authorization process applies) [1] |
| Visit limits | Testing is limited to once per calendar year; more than one claim per year may get a records and medical necessity review. Base codes may only be used once per testing episode. Submit the claim after all testing services are complete, even across several days. [1] |
| Prior authorization | Initial testing requests must show a valid DSM or ICD-10 diagnosis (or rule-out) and a fully licensed clinician whose state board allows testing in their scope; if the patient was referred, the referral should come from a licensed physician or licensed behavioral health practitioner. List the requested CPT codes and related DSM diagnoses. Some contracts exclude testing or specific diagnoses. [1] |
| Who can bill | In South Carolina, reimbursement for testing is limited to physicians and psychologists or supervising psychologists eligible under the state Board of Examiners in Psychology. Licensed Professional Counselors are not authorized to perform psychological testing; requests from LPCs in other states are reviewed case by case. [1] |
| Also | Tests must not be primarily for educational purposes, including poor academic performance, accommodations, evaluation of learning disabilities, grade placement and IEP planning. Testing for job placement, disability claims or court purposes is also excluded. Autism testing by licensed psychoeducational specialists may be approved under the autism benefit (CAM 387). [1] |
- BlueCross BlueShield of South Carolina: Psychological and Neuropsychological Testing, CAM 397, checked October 30, 2026
What BlueCross BlueShield of South Carolina's documents say
The table above has every field we found for BlueCross BlueShield of South Carolina, with numbered sources. In short:
- Prior authorization. Initial testing requests must show a valid DSM or ICD-10 diagnosis (or rule-out) and a fully licensed clinician whose state board allows testing in their scope; if the patient was referred, the referral should come from a licensed physician or licensed behavioral health practitioner. List the requested CPT codes and related DSM diagnoses. Some contracts exclude testing or specific diagnoses.
- Visit limits. Testing is limited to once per calendar year; more than one claim per year may get a records and medical necessity review. Base codes may only be used once per testing episode. Submit the claim after all testing services are complete, even across several days.
- Who can bill. In South Carolina, reimbursement for testing is limited to physicians and psychologists or supervising psychologists eligible under the state Board of Examiners in Psychology. Licensed Professional Counselors are not authorized to perform psychological testing; requests from LPCs in other states are reviewed case by case.
- Codes. 96116, 96121, 96130, 96131, 96132, 96133, 96136, 96137, 96138 and 96139 are listed.
Other psychological testing rows for South Carolina
South Carolina Medicaid (RBHS).
Check BlueCross BlueShield of South Carolina's claim against the row
Before the claim goes out, compare it with the row above: the evaluation and administration codes pair the way the policy says, the hours fit any cap, the referral question is documented, and prior authorization covers the units. The psychological testing table compares BlueCross BlueShield of South Carolina with every other payer we checked.