Effective for dates of service on or after Sept. 15, 2022, the South Carolina Department of Health, and Human Services (SCDHHS) will expand coverage for additional pneumococcal immunizations for Healthy Connections Medicaid members 19 years of age and older under the pharmacy and medical benefit.
SCDHHS will reimburse providers for the administration of the immunizations in accordance with the Centers for Disease Control and Prevention (CDC) and the Advisory Committee on Immunization Practices (ACIP) Adult Immunization Schedule for the following Healthcare Common Procedure Coding System (HCPCS) codes:
- Pneumococcal 15-valent conjugate vaccine (PCV15): HCPCS Code 90671
- Pneumococcal 20-valent conjugate vaccine (PCV20): HCPCS Code 90677
The new codes will be reflected on the Physicians Fee Schedule and updates to the Physicians Services provider manual will be available by Sept. 15, 2022.
Pharmacy reimbursement utilizes the standard basis of payment for the fee-for-service pharmacy benefit at the lowest of:
- The actual acquisition cost (AAC) plus a professional dispensing fee (PDF) of $10.50;
- The state’s maximum allowable cost plus a PDF of $10.50; or,
- The usual and customary charges to the public.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.