Physician Services Provider Manual Updates
The South Carolina Department of Health and Human Services (SCDHHS) is announcing updates to several policies outlined in its Physician Services Provider Manual. The policy changes described in this bulletin are effective for dates of service on or after Sept. 1, 2025.
Genetic Testing for Spinal Muscular Atrophy (SMA)
SCDHHS will require prior authorization for the SMA genetic testing procedure codes listed below.
| Procedure Code | Code Description | Prior Authorization |
|---|---|---|
| 81329 | SMN1 gene analysis; dosage/deletion analysis, includes SMN2 | Yes |
| 81336 | SMN1 gene analysis; full gene sequencing | Yes |
| 81337 | SMN1 gene analysis; known familial sequence variant | Yes |
Circumcisions for Members Older than 28 Days of Age
SCDHHS will no longer require a prior authorization for medical justification of Current Procedural Terminology code 54161-circumcision, surgical excision other than clamp, device or dorsal slit, older than 28 days of age. Providers must maintain documentation justifying the medical necessity for the service in the patient’s health record.
South Carolina’s Medicaid managed care organizations (MCOs) are responsible for the authorizations, coverage and reimbursement related to the services described in this bulletin for members enrolled in an MCO.
Providers should direct questions related to this bulletin to the Provider Service Center (PSC). PSC representatives can be reached at (888) 289-0709 from 7:30 a.m.-5 p.m. Monday-Thursday and 8:30 a.m.-5 p.m. Friday. Providers can also submit an online inquiry at https://www.scdhhs.gov/providers/contact-provider-representative.
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