---
title: "South Carolina Medicaid ABA coverage: the intake guide."
url: "https://carelu.com/payers/south-carolina-medicaid"
markdown_url: "https://carelu.com/payers/south-carolina-medicaid.md"
state: SC (South Carolina)
payer: South Carolina Healthy Connections Medicaid
kind: State Medicaid program
description: "How South Carolina Healthy Connections Medicaid covers ABA: the July 2026 ASD Services manual, who may diagnose, QIO prior authorization, the narrowed telehealth rules, the published fee schedule, the five MCOs, and the in-state (SCMSA) provider rule."
last_reviewed: October 2026
---

# South Carolina Medicaid ABA coverage: the intake guide.

_Payer Guide · South Carolina Medicaid · Last updated October 2026 · 13 primary sources_

> Healthy Connections covers ABA under 21 through the ASD Services manual; five MCOs run it for most children, Acentra (QIO) authorizes FFS, and the July 2026 manual narrowed telehealth.

South Carolina Healthy Connections Medicaid covers applied behavior analysis for members through age 20 under its Autism Spectrum Disorder (ASD) Services Provider Manual. A new edition took effect July 1, 2026: it tightened who may diagnose, cut back ABA telehealth, added required assessment instruments, and treats parent training (97156) as a required part of every ABA authorization.

Most children are enrolled in one of five managed care plans: Absolute Total Care, Healthy Blue by BlueChoice, Humana Healthy Horizons, Molina Healthcare and First Choice by Select Health. The plan then authorizes and pays for ABA. Fee-for-service members go through SCDHHS’s quality improvement organization, Acentra. In both cases the state manual is the baseline, and three of the five plans say they follow it.

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment**: Fee-for-service: no. "97151 does not require prior authorization," but SCDHHS reviews and can recoup it if the member cannot start 97153 within one month or the BIA was done by telehealth. 97152 does need prior authorization. MCO members follow their plan [1][2]
- **Prior auth for treatment**: Fee-for-service: yes. "All ASD services must be determined medically necessary and have a prior authorization by the QIO" (Acentra), reviewed against InterQual’s ABA criteria; authorizations last six months [1]
- **Autism diagnosis required?**: Yes, or a recognized equivalent: a DSM diagnosis of ASD, an IDEA school designation of ASD or a BHDD-OIDD autism eligibility determination confirmed by a physician; children 18–36 months at risk can be presumptively eligible until age 6 [1]

## At a glance

- **Covers ABA?:** Yes, ages 0–20 (through the last day of the month of the 21st birthday)
- **Structure:** Five MCOs authorize and pay for enrolled members; FFS members use the QIO (Acentra)
- **FFS prior auth:** All ABA treatment via Acentra, InterQual criteria, six-month authorizations; 97151 has no PA
- **FFS rates (per 15 min):** 97151 $23.51 · 97152 $20.50 · 97153 $14.88 · 97154 $9.10 · 97155/97156 $21.25 · 97157 $13.31 · 97158 $13.00 · 0362T $27.95 · 0373T $30.00
- **Who may diagnose:** MD/DO, PhD/PsyD psychologist or LPES, in person; not NPs, PAs, LISWs or ABA providers
- **Telehealth:** 97156 (GT) allowed; 97155 only with QIO approval, up to 25%; the 97151 assessment never
- **Licensure:** None: SC does not license behavior analysts; BACB certification governs
- **Where providers must be:** Inside the SC Medical Service Area, telehealth included

## Who is covered, and who must make the diagnosis

The manual covers "eligible Medicaid members age 0 through 20 years (up to the last day of the month of the member’s 21st birthday)" who have one of three things: a DSM diagnosis of ASD at the time of the initial assessment, an IDEA designation meeting the SC Department of Education standard for autism "confirmed by a physician involved with the member’s care," or an autism eligibility determination from the Department of Behavioral Health and Developmental Disabilities’ Office of Intellectual and Developmental Disabilities (BHDD OIDD), also physician-confirmed. Under EPSDT, a child aged 18–36 months whose risk of ASD is documented by IDEA Part C (BabyNet) or by a physician using RITA-T or STAT can be presumptively eligible for ABA, but that eligibility "will lapse" without a DSM diagnosis before the child’s 6th birthday. [1][2]

The comprehensive diagnostic assessment must be administered directly by a licensed physician (MD/DO), licensed psychologist (PhD/PsyD) or licensed psycho-educational specialist (LPES). A medical-care-home physician may confirm a prior diagnosis, or make an initial diagnosis for a medically uncomplicated child aged 18–36 months. SCDHHS "does NOT accept autism evaluations completed by any other provider type," naming nurse practitioners, physician assistants, LISWs, ABA providers and ST/OT/PT; a school IDEA designation of ASD or a BHDD-OIDD autism eligibility determination counts once a physician confirms it. Diagnoses made by telehealth are not valid. The comprehensive diagnostic assessment must include a DSM checklist with severity levels and an in-person ADI-R, ADOS or CARS ("Autism measures administered via Telehealth are not considered valid"), plus a cognitive or developmental measure. An out-of-state or private evaluation must meet the same standard. New for treatment requests from July 1, 2026: ABA is not reimbursable when the ABA provider is affiliated with the clinic or group that made the diagnosis. [1][2]

## Prior authorization: the QIO, InterQual, and what the packet needs

For fee-for-service members, "All ASD services must be determined medically necessary and have a prior authorization by the QIO." The QIO is Acentra (scdhhs.acentra.com; phone (855) 326-5219; fax (855) 300-0082), which "will use InterQual’s Applied Behavior Analysis Treatment Criteria," and "All prior authorizations will be valid for a period of six months." The exception is the assessment: "97151 does not require prior authorization," though SCDHHS reviews and can recoup it if the member cannot start 97153 within one month of the assessment, if the assessment was done by telehealth, or if the provider has no capacity to deliver the treatment it recommends. 97152 requires prior authorization. [1][2]

An initial request needs the diagnostic documentation, the behavior identification assessment (BIA), a functional behavior assessment whenever maladaptive behavior is targeted, more than 15 hours a week of 97153 is requested, or services are planned at school, current ST/OT/PT treatment plans, and the individualized plan of care (IPOC). The BIA must include a Vineland interview (all domains), the Behavioral Health Index, a QABF or FAST administered to the caregiver, and at least one skills assessment (PEAK, VB-MAPP with barriers and transitions, ABLLS-R, SRS, AFLS, EFL, ESDM or PAS-BOS). Every request must show 97153, 97155 and 97156 together: SCDHHS will not authorize ABA "without routine and consistent delivery of 97156," and requires at least one hour of 97156 in each month of 97153. Continued requests go in 30 to 10 days before the authorization ends. [1][2]

## Managed care: the five plans own authorization and payment

SCDHHS says in its July 2026 manual bulletin that the "Medicaid managed care organizations (MCOs) are responsible for the authorizations, coverage and reimbursement" of ASD services "for members enrolled in an MCO," and the ASD manual itself says that for MCO members "providers must follow the member’s MCO’s policies and requirements." SCDHHS lists five MCOs: Absolute Total Care, BlueChoice (Healthy Blue), Humana Healthy Horizons, Molina and Select Health (First Choice). Its carve-in page gives each plan’s prior-authorization and provider help line: Absolute Total Care (866) 433-6041, Healthy Blue (866) 757-8286, Molina (855) 237-6178, First Choice (888) 559-1010 and Humana (866) 432-0001. Healthy Blue, First Choice and Humana say in their own manuals that they follow the SCDHHS ASD manual; Absolute Total Care and First Choice require authorization even for the 97151 assessment, which fee-for-service does not. [3][1][6][7]

## What does South Carolina Medicaid pay for ABA?

The ASD Services Fee Schedule (file dated 7-1-2026; each page reads "Effective: 8/13/2026") pays, per 15-minute unit and at the same rate for BCBA, BCBA-D or BCaBA: 97151 $23.51, 97152 $20.50, 0362T $27.95, 97153 $14.88, 97154 $9.10, 97155 $21.25 (GT telehealth "Only with Prior Authorization," priced the same), 0373T $30.00, 97156 $21.25 (GT priced the same), 97157 $13.31 and 97158 $13.00. Non-ABA ASD treatment by a licensed independent practitioner (H2019) pays $14.55. RBTs do not bill on their own: "RBT must bill under a BCBA-D, BCBA, or BCaBA." The MCOs pay contracted rates, which are not published. [4][1]

## Can an out-of-state BCBA treat a South Carolina Medicaid member, including by telehealth?

Not from outside the region. South Carolina does not license behavior analysts, so there is no state license to obtain, but the Medicaid rule is about location: "Except as required by 42 CFR 431.52, providers of ASD services must be located within the South Carolina Medical Service Area (SCMSA)," and ABA providers must also be BACB-certified and Medicaid-enrolled. SCDHHS’s July 2026 training adds that "Providers delivering ABA services via telehealth must also be within the SCMSA (within 25 miles of South Carolina border)," and that services billed by providers outside it are subject to recoupment. Telehealth itself is limited to 97156 and, with QIO approval, part of 97155. [1][2][8][9]

## Claims: timely filing, NPIs, modifiers and appeals

SCDHHS pays only clean claims "received and entered into the claims processing system within one year from the date of service"; retroactive-eligibility claims get six months from the eligibility add date (three years outside). Enrolled providers may not bill under their NPI for a non-enrolled provider’s services, except for services delivered under their supervision, and RBT services bill under the supervising BCBA-D, BCBA or BCaBA. Every clinical service note must be signed by the enrolled BCBA, BCaBA or LIP under whose NPI the service was billed, and by the BT or RBT who rendered it; SCDHHS does not let a group name a general "authorized signee." Telehealth lines carry GT in the second modifier position. Units follow the Medicare eight-minute rule. A provider appeal must be filed within 30 days of the notice of adverse action or of the remittance advice showing a reconsideration denial, whichever is later. The ASD manual and the billing manual do not mention electronic visit verification for ABA. [5][1][2]

Filing and payment, from the billing manual (July 1, 2026): the one-year limit covers corrections too, since providers must ensure "that all claims are filed and corrected within Medicaid policy requirements," and a void/replacement claim (electronic replacement, or DHHS Form 130 on paper) is how a paid claim is corrected or third-party payment information added. Other insurance does not buy time: the one-year limit "will not be extended because of third-party liability requirements." When Medicare is primary, the claim is due within two years of the date of service or six months after Medicare’s payment, whichever is later. SCDHHS pays by EFT only, and "The payment made weekly is the sum total of all claims on the remittance advice with status P." The manual publishes no weekly submission cut-off day or time. [5][1][2]

## What a continued-treatment request must contain

The ASD manual (July 1, 2026) asks for "a thorough explanation" of progress toward reducing target behaviors, reducing deficits "(as demonstrated by assessment instrument scores over time)" or gaining new skills, and toward the transition and fade criteria; where progress stalled, the variables that impeded it, and for any extended mastery date a narrative naming the new date, the barrier and the changes made. With the SCDHHS ASD Prior Authorization Request Form go the most recent IPOC and "progress summary spanning the previous authorized treatment period," updated direct observations, the school’s updated educational and behavioral assessments, and all updated ST/OT/PT plans. Requests go to the QIO "up to 30 days prior and no later than 10 days prior to the expiration of authorized visits"; services without reauthorization risk denied claims. The annual review adds all progress summaries, an updated BIA and, where maladaptive behavior, more than 15 hours of 97153 or school-based services are involved, an updated FBA. [1]

Graphs are required. The ASD Therapy Progress Summary Report must include the IPOC objectives treated, the interventions used, goals met, "Cumulative graphs of goals and objectives demonstrating progress or areas of concern (ABA providers only), including baseline data," explanations of delayed progress and barriers, and the plan and caregiver coordination summary for the next period, signed by the team including the caregiver. It is completed "no sooner than 30 days prior to the expiration of the current authorization period and no later than the 10th day of the month immediately following the last date of authorized treatment," and must cover every date of service not reported in an earlier summary. [1]

## Intake gates

The questions that decide whether a family can start with South Carolina Healthy Connections Medicaid, and what they have to bring.

- **Age limit**: Ages 0 through 20, "up to the last day of the month of the member’s 21st birthday." Presumptive eligibility (for at-risk children assessed at 18–36 months) lasts only until the 6th birthday unless a DSM diagnosis is documented. [1]
- **Diagnosis recency**: No expiry on the diagnosis itself: it must meet DSM criteria "at the time of the initial assessment," and SCDHHS does not require re-diagnosis or repeat psychological testing. Prior school (DOE) and BHDD-OIDD determinations stay valid; other prior evaluations must meet the full diagnostic-assessment standard. The BIA instruments must be updated with every initial or continuing request. [1][2]
- **Who may diagnose**: The comprehensive diagnostic assessment must be administered directly by a licensed physician (MD/DO), licensed psychologist (PhD/PsyD) or licensed psycho-educational specialist (LPES). A medical-care-home physician may confirm a prior diagnosis, or make an initial diagnosis for a medically uncomplicated child aged 18–36 months. SCDHHS "does NOT accept autism evaluations completed by any other provider type," naming nurse practitioners, physician assistants, LISWs, ABA providers and ST/OT/PT; a school IDEA designation of ASD or a BHDD-OIDD autism eligibility determination counts once a physician confirms it. Diagnoses made by telehealth are not valid. [1][2]
- **Diagnostic tools required**: Comprehensive diagnostic assessment: one of ADI-R, ADOS or CARS administered in person by the diagnosing clinician, a DSM checklist with severity levels, and a standardized cognitive or developmental measure. Medical-care-home diagnosis (18–36 months): a developmental screen (e.g., ASQ), an at-risk primary autism screen (e.g., M-CHAT) and RITA-T of 18 or more or STAT of 3.0 or more. Presumptive eligibility: RITA-T of 12 or more or STAT of 2.00 or more. [1]
- **Referral required?**: ASD services "must be recommended by a physician or other licensed practitioner of the healing arts within his or her scope of practice under state law." For treatment, the manual recognizes three routes: a physician or LPHA refers a member with a prior-established ASD diagnosis to an ASD-network ABA provider or LIP; the member self-refers on that prior-established diagnosis; or a physician refers a member with presumptive eligibility (Section 8). Referrals "can be done via phone, email, fax and hard copy mail," and the provider's record must contain a "Referral form" alongside the BIA and signed IPOC. In practice the recommendation comes from the diagnosing evaluation: the comprehensive diagnostic assessment must list recommendations based on medical necessity, including a "Referral for applied behavior analysis therapy if indicated." The manual sets no validity period for the referral; the July 2026 ASD manual's initial-request packet carries the diagnostic assessment (or physician documentation of a Medical Care Home assessment or of presumptive eligibility) instead. [1]
- **Telehealth**: Under the SCDHHS ASD manual (July 1, 2026), only two ABA codes may be delivered by telehealth: 97156 (family guidance), with the GT modifier and no extra authorization, and 97155 (protocol modification), only when the QIO approves it during prior authorization, for up to 25% of authorized and rendered 97155 units, for a member receiving in-home ABA in a rural location with limited access. Telehealth must be synchronous audio and video, GT goes in the secondary modifier position, and POS is 02 or 10. "The BIA can not be completed by telehealth," and 97152, 97153, 97154, 97157, 97158, 0362T and 0373T are not deliverable by telehealth. An ASD diagnosis made by telehealth is not valid. The member must be at a referring site inside the SCMSA, and the ABA provider must also be located in the SCMSA. [1][2][3][4]
- **Prior-auth decision time**: The ASD manual sets no decision clock for the QIO. The federal fee-for-service floor applies: since January 1, 2026 the state agency must decide a standard request "in no case later than 7 calendar days after receiving the request" (extendable by up to 14 days) and an expedited one within 72 hours. Continued and annual requests go in 30 to 10 days before the authorization expires. MCO members follow their plan’s clock (42 CFR 438.210(d): 7 calendar days for rating periods starting on or after January 1, 2026). [1][10][11]
- **Other insurance (who pays first)**: Medicaid is payer of last resort: providers "shall consider Medicaid the payer of last resort and bill any liable third-party insurance plan prior to billing Medicaid." For ASD services, members with Medicare or another payer "are only required to obtain a prior authorization if Medicare or the primary carrier denied the service or the service is considered not covered." EPSDT claims are exempt from up-front cost avoidance: if a provider chooses not to bill a liable third party, SCDHHS pays and recovers from that party itself. The one-year filing limit is not extended because of third-party billing. [5][1][12]

## Delivery and billing rules

Coverage decides whether South Carolina Healthy Connections Medicaid pays. These decide whether the claim survives: staffing and supervision, concurrent billing, per-day ceilings, who signs the note, where the service is payable, and whose NPI the claim goes out under.

- **Supervision**: BACB supervision applies: "each RBT must be supervised for a minimum of 5% of the hours spent providing ABA services per month," with at least two face-to-face, real-time contacts a month, one of which observes the RBT with the member; that professional supervision is not billable. Caseload caps: a BCBA may carry 12 cases (16 with a BCaBA), a BCaBA 12, where 30–40 hours a week is one case, 10–25 hours half a case and under 10 hours a quarter case. A behavior technician gets one 90-day grace period to earn the RBT credential, and may work only in a clinic with a BCBA on site during it. BCaBAs must be supervised by a BCBA-D or BCBA and must disclose that supervision to the family in the consent form. [1][2]
- **Concurrent billing (97153 + 97155)**: Limited. The manual excludes "Concurrent billing of 97153 with any other service" except as detailed in section 8, and "Two enrolled ABA providers billing at the same time under one CPT code." The July 2026 training spells out the exceptions: 97155 may be billed with 97153 when the notes show two providers each delivering a direct service to the member at the same time (not while teaching an RBT the initial protocol), and 97153 may run alongside 97156 when the RBT works with the child in a separate space from the BCBA training the caregiver. 0373T may not be billed with 97155, and 97152 may not be billed with any treatment code. ABA alongside speech, OT or PT: the manual's non-covered list is explicit — "Concurrent billing of 97153 with any other service or therapy is excluded except as detailed in Section 8," and Section 8's exceptions are ABA-with-ABA only. It also excludes "ABA services while the member is at another medical appointment," and, in the other direction, ABA treatment "that precludes, or requires the member's family to stop engaging with other critical supports … speech therapy, occupational therapy, or IDEA recommended school-based curriculum and supports." So speech and ABA can both continue, but not on the same clock time as a billed 97153 unit. The manual also binds providers to the National Correct Coding Initiative edits and related coding policy unless it says otherwise. [1][2]
- **Daily limits / MUEs**: Section 8 limits: 97151, 32 units a year and 12 a day; 97152, 21 units a day; 0362T, 16 a day; 97153, 160 units a week; 97154 and 97158, groups of 2–6 for up to 6 hours a day; 97155, up to 10% of rendered 97153 and no more than 64 units a month; 0373T, 32 a day; 97156, 96 units (24 hours) a year; 97157, 16 a day. [1]
- **Session-note signature**: Each discrete service needs its own clinical service note, signed, titled and dated "by both the enrolled BCBA, BCaBA, or LIP as applicable, as well as the BT/RBT rendering the service," and records must be signed before the claim is filed. A BT also writes the date their 90-day grace period began. SCDHHS does not allow a group to designate a general "authorized signee," and notes may not be copied forward. [1][2]
- **Place of service**: Home (POS 12), office/clinic (11), school (03, including daycare and preschool, only with prior authorization tied to a current IEP, FBA and BIP), telehealth (02/10, limited codes) and other community settings (99) only when the QIO approves them. In the home an adult caregiver must be present for the entire session and the technician must be a credentialed RBT or higher; uncredentialed BTs may work only in a clinic. Sporting events, camps and services during other medical appointments are excluded. [1][2]
- **Bill as provider**: The enrolled BCBA-D, BCBA or BCaBA (or LIP) is the billing provider: "RBT must bill under a BCBA-D, BCBA, or BCaBA," 0362T and 0373T are billed "by the qualified primary provider," and an enrolled provider may not use its NPI for a non-enrolled provider’s services except those delivered under its supervision. The QIO approval letter names the ASD provider’s NPI. [1]

## What intake should collect for South Carolina Healthy Connections Medicaid

- **Which Medicaid card:** Absolute Total Care, Healthy Blue, Humana, Molina, First Choice, or fee-for-service. The plan owns authorization and payment.
- **Diagnostic report from an accepted clinician:** MD/DO, PhD/PsyD or LPES, in person, with ADI-R/ADOS/CARS and a DSM checklist; or a physician-confirmed IDEA or BHDD-OIDD autism determination.
- **Who made the diagnosis:** ABA is not reimbursable from a provider affiliated with the group that diagnosed the child (new requests from July 1, 2026).
- **School and therapy records:** Current IEP, FBA and BIP if school-based ABA is planned, plus ST/OT/PT treatment plans for the request.
- **Other insurance:** Commercial coverage goes first; the Medicaid authorization is needed only if the primary denies or does not cover ABA.
- **Caregiver availability:** In-home ABA requires an adult caregiver present the whole session, and 97156 parent training is required every month.

Free verification-call checklist (PDF): https://carelu.com/downloads/aba-verification-call-checklist.pdf

## Common questions

### Does SC Medicaid require graphs for ABA reauthorization?

Yes. The ASD Therapy Progress Summary Report must include cumulative graphs of goals and objectives with baseline data, and the continued-treatment request sent to the QIO 30 to 10 days before the authorization ends must include the most recent IPOC and the progress summary for the previous authorized period, plus updated observations, school assessments and therapy plans.

### When does SC Medicaid pay ABA claims, and is there a weekly cut-off?

SCDHHS pays weekly by EFT, the total of the claims shown as paid (status P) on that week’s remittance advice. The billing manual publishes no submission cut-off day or time. Corrections and other-insurance claims must still land within one year of the date of service (two years, or six months after Medicare pays, when Medicare is primary).

### Does South Carolina Medicaid cover ABA therapy?

Yes, for Healthy Connections members through age 20 under the ASD Services manual. Most children are in one of five managed care plans, which authorize and pay; fee-for-service members get authorization from the QIO, Acentra.

### Who can diagnose autism for South Carolina Medicaid ABA?

A licensed physician (MD/DO), licensed psychologist (PhD/PsyD) or licensed psycho-educational specialist, in person, with ADI-R, ADOS or CARS. A primary care physician may confirm a prior diagnosis or diagnose a medically uncomplicated child aged 18–36 months. Evaluations by NPs, PAs, LISWs or ABA providers, and any telehealth diagnosis, are not accepted.

### Does the ABA assessment need prior authorization?

Not for fee-for-service: 97151 has no prior authorization, but it is reviewed after payment, and the child must start treatment within a month. Absolute Total Care and First Choice do require authorization for the assessment, so check the member’s plan.

### What does South Carolina Medicaid pay for ABA?

Per 15-minute unit on the 2026 ASD fee schedule: 97151 $23.51, 97152 $20.50, 97153 $14.88, 97154 $9.10, 97155 and 97156 $21.25, 97157 $13.31, 97158 $13.00, 0362T $27.95, 0373T $30.00. MCO rates are contracted.

### Can ABA be done by telehealth in South Carolina Medicaid?

Only partly, since July 1, 2026. 97156 parent training may be delivered by telehealth with the GT modifier. 97155 may be, for up to 25% of units, only if the QIO approves it for a rural in-home case. The assessment and technician services must be in person.

### Can a BCBA outside South Carolina serve Medicaid members by telehealth?

Generally no. South Carolina has no behavior-analyst license, but SCDHHS requires ASD providers, including telehealth providers, to be located within the South Carolina Medical Service Area (within about 25 miles of the border), Medicaid-enrolled and BACB-certified.

### What is the timely filing limit for SC Medicaid ABA claims?

One year from the date of service for fee-for-service claims, with longer limits only for retroactive eligibility. The MCOs each publish their own limit, which is also 365 days or one year for all five.

## Primary sources

1. [SCDHHS — Autism Spectrum Disorder (ASD) Services Provider Manual (July 1, 2026)](https://www.scdhhs.gov/sites/dhhs/files/documents/ASD%20Services%20Provider%20Manual%207.1.26.pdf)
2. [SCDHHS — ASD Services Provider Manual Policy Updates, provider training (July 9, 2026)](https://scdhhs.gov/sites/dhhs/files/ASD%20provider%20training%20_%20July%202026%20Update.pdf)
3. [SCDHHS Medicaid Bulletin MB# 26-015 — Updates to ASD Services Provider Manual (May 15, 2026; effective July 1, 2026)](https://www.scdhhs.gov/communications/updates-asd-services-provider-manual)
4. [SCDHHS — ASD Services Fee Schedule (file dated 7-1-2026; page header "Effective: 8/13/2026")](https://www.scdhhs.gov/sites/dhhs/files/ASD%20Services%20FEE%20SCHEDULE%20%207-1-2026.pdf)
5. [SCDHHS — Provider Administrative and Billing Manual (July 1, 2026)](https://www.scdhhs.gov/sites/dhhs/files/Provider%20Administrative%20and%20Billing%20Guide.pdf)
6. [SCDHHS — Managed Care Organizations (the five Healthy Connections MCOs)](https://www.scdhhs.gov/providers/managed-care/managed-care)
7. [SCDHHS — Managed Care Carve-in (Jan. 1, 2026; MCO prior-authorization and provider help lines)](https://scdhhs.gov/partners/managed-care/managed-care-carve)
8. [BACB — U.S. Licensure of Behavior Analysts (South Carolina not listed)](https://www.bacb.com/u-s-licensure-of-behavior-analysts/)
9. [S.C. Code Title 40, Chapter 75 — Professional counselors, MFTs, addiction counselors and psycho-educational specialists (no behavior-analyst article)](https://www.scstatehouse.gov/code/t40c075.php)
10. [42 CFR 440.230(e) — State Medicaid agency prior-authorization timeframes (eCFR)](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-440/subpart-B/section-440.230)
11. [42 CFR 438.210(d) — Medicaid managed care authorization timeframes (eCFR)](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-438/subpart-D/section-438.210)
12. [42 CFR 433.139 — Medicaid third-party liability (eCFR)](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-433/subpart-D/section-433.139)
13. [SCDHHS — Communications: Medicaid bulletins index](https://www.scdhhs.gov/communications)

Payer policies change frequently and vary by plan, state, and funding type. This guide was compiled from the sources above and last reviewed October 2026; it is general information, not billing, legal, or clinical advice. Always verify current requirements against the payer's live policy and a benefits check for the specific member.

Source: Carelu ABA Payer Directory — https://carelu.com/payers. Free to cite with attribution.