96130 with South Carolina Medicaid (RBHS): what the policy says
The short answerCovered for licensed psychologists with modifier AH: one 96130 per day, and no more than 24 units a year in combination with 96131, 96136 and 96137. The manual's DAODAS-only table also lists Licensed Psychoeducational Specialists (modifier HO).
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 policy says about 96130
96130 is the CPT code for psychological testing evaluation services, first hour. At South Carolina Medicaid (RBHS) it is limited: paid only in a narrow case, see the note. Each line below is from the cited text:
- Units. Not to exceed 24 units per year in combination with 96131, 96136 and 96137. (South Carolina DHHS, checked October 30, 2026)
- How often. 1 per day. (South Carolina DHHS, checked October 30, 2026)
- Who can bill it. Licensed Psychologist, modifier AH. The manual's DAODAS-only table also lists the Licensed Psychoeducational Specialist, modifier HO. (South Carolina DHHS, checked October 30, 2026)
96130 at other payers
- 96130 with Medicare (national): listed.
- 96130 with UnitedHealthcare and Optum Behavioral: limited.
- 96130 with Washington Apple Health: limited.
- 96130 with Nevada Medicaid: listed.
The rest of South Carolina Medicaid (RBHS)'s psychological testing rules
The South Carolina Medicaid (RBHS) row has its codes, telehealth rule, limits and authorization, each with its source. Other codes we checked at South Carolina Medicaid (RBHS): 96137. Before the claim goes out, compare it with the row in the table above.