South Carolina Medicaid (RBHS) psychological testing coverage: codes, limits and who can bill
By Javier Alvarez · Updated · 1 min read
1 row: Medicaid (by state) · South Carolina. Public policy, not the member's benefits.
South Carolina Medicaid (RBHS)
Rehabilitative Behavioral Health Services Provider Manual, Section 4 (updated 01/01/25) · South Carolina
| 96130 | Listed (licensed psychologist (modifier AH), or Licensed Psychoeducational Specialist (modifier HO) in the manual's DAODAS-only table; counts toward 24 units per year) [1] |
|---|---|
| 96131 | Listed (licensed psychologist (modifier AH), or Licensed Psychoeducational Specialist (modifier HO) in the manual's DAODAS-only table; counts toward 24 units per year) [1] |
| 96136 | Listed (licensed psychologist (modifier AH), or Licensed Psychoeducational Specialist (modifier HO) in the manual's DAODAS-only table; counts toward 24 units per year) [1] |
| 96137 | Listed (licensed psychologist (modifier AH), or Licensed Psychoeducational Specialist (modifier HO) in the manual's DAODAS-only table; counts toward 24 units per year) [1] |
| Visit limits | Per day: 96130 and 96136 once, 96131 up to five hours, 96137 up to six units. Per year: no more than 24 units in combination across 96130, 96131, 96136 and 96137. [1] |
| Who can bill | In the general table of SC Medicaid's Rehabilitative Behavioral Health Services manual, 96130, 96131, 96136 and 96137 are listed only for the Licensed Psychologist (modifier AH). The manual's DAODAS-only table also lists the Licensed Psychoeducational Specialist (modifier HO) for these codes and adds 96138, 96139 and 96146, limited to 40 units per year in combination. 96132 and 96133 do not appear. [1] |
What South Carolina Medicaid (RBHS)'s documents say
The table above has every field we found for South Carolina Medicaid (RBHS), with numbered sources. In short:
- Visit limits. Per day: 96130 and 96136 once, 96131 up to five hours, 96137 up to six units. Per year: no more than 24 units in combination across 96130, 96131, 96136 and 96137.
- Who can bill. In the general table of SC Medicaid's Rehabilitative Behavioral Health Services manual, 96130, 96131, 96136 and 96137 are listed only for the Licensed Psychologist (modifier AH). The manual's DAODAS-only table also lists the Licensed Psychoeducational Specialist (modifier HO) for these codes and adds 96138, 96139 and 96146, limited to 40 units per year in combination. 96132 and 96133 do not appear.
- Codes. 96130, 96131, 96136 and 96137 are listed.
Codes we checked at South Carolina Medicaid (RBHS)
What Medicaid's own text says about one code: 96130 and 96137.
Other psychological testing rows for South Carolina
BlueCross BlueShield of South Carolina.
Check South Carolina Medicaid (RBHS)'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 Medicaid with every other payer we checked.