South Carolina Medicaid (Healthy Connections)

MedicaidSC

ABA billing requirements · Source: South Carolina Medicaid — ABA Services Policy

High confidence

Verified 2026-03-01

Authorization Requirements

Requires prior auth Yes

Initial auth duration6 months

Renewal auth duration6 months

Submission deadline10 days

Unit tracking cadenceTotal

Requires FBA Yes

Diagnostic eval validityN/A

Re-eval cadenceEvery 12 months

State licensure requiredBCBA state licensure required via SC Department of Labor, Licensing and Regulation

Documentation Requirements

Parent signatures required Yes

Start/stop times required Yes

Treatment plan componentsMember's strengths, Needs, Abilities, Preferences, Goals and objectives of treatment, Outline to address assessed needs, Specific treatment activities or interventions, Amount and type of parent/caregiver participation, Date of each completed progress summary and annual re-development, Signature, title and date by the multidisciplinary team members including the parent and/or caregiver

Progress summary cadenceEvery 3 months

Policy Notes

Services are provided to eligible Medicaid members age 0 through 20 years. ABA providers must be located within the South Carolina Medical Service Area (SCMSA). BCBAs without BCaBA support have a maximum of 12 cases, with BCaBA support, 16 cases. BCaBAs have a maximum of 16 cases. Caseload counts are dependent on hours per week (30-40 hrs = 1 case, 10-25 hrs = 0.5 case, <10 hrs = 0.25 case).

CPT & Modifier Rules

CPT rules require a free account

View H-codes, modifiers, unit limits, and billing restrictions for South Carolina Medicaid (Healthy Connections).

Official policy source:South Carolina Medicaid — ABA Services Policy

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Data last verified: 2026-03-01 · Confidence: High · See our methodology

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