South Carolina Medicaid reimbursement rates
177,358 current fee-for-service and managed-care rates from South Carolina Medicaid, across 119 services and 8 programs, normalized by code, provider level and unit. Each links to one of 46 official source documents.
Last retrieved 2026-10-05. History back to 2003-10-16.
- Current rates
- 177,358
- Services
- 119
- Programs
- 8
- Lines with a plan rule
- 0of 15 service lines
By industry
Applied behavior analysis (ABA)South Carolina rates, labor costs and changesBehavioral healthSouth Carolina rates, labor costs and changesHome healthSouth Carolina rates, labor costs and changesHome care & personal careSouth Carolina rates, labor costs and changesPrivate duty nursingSouth Carolina rates, labor costs and changesSkilled nursing facilitiesSouth Carolina rates, labor costs and changesHospiceSouth Carolina rates, labor costs and changesIntellectual & developmental disabilitiesSouth Carolina rates, labor costs and changesOutpatient therapy (PT, OT, speech)South Carolina rates, labor costs and changes
South Carolina rates by service
The median current rate for each service, like-for-like by unit. Follow a service to compare it with every other state.
| Service | Line | Median rate | Unit | Per hour | Variants |
|---|---|---|---|---|---|
| ABA assessment by a behavior analyst | ABA / autism services | $23.51 | 15 min | $94.04 | 1 |
| ABA assessment support by a technician | ABA / autism services | $20.50 | 15 min | $82.00 | 1 |
| ABA assessment with 2+ technicians (severe behavior) | ABA / autism services | $27.95 | 15 min | $111.80 | 1 |
| ABA parent and caregiver training | ABA / autism services | $21.25 | 15 min | $85.00 | 1 |
| ABA therapy with 2+ technicians (severe behavior) | ABA / autism services | $30.00 | 15 min | $120.00 | 1 |
| ABA therapy with plan changes by an analyst | ABA / autism services | $21.25 | 15 min | $85.00 | 1 |
| Group ABA parent training (several families) | ABA / autism services | $13.31 | 15 min | $53.24 | 1 |
| Group ABA therapy led by a technician | ABA / autism services | $9.10 | 15 min | $36.40 | 1 |
| Group ABA therapy led by an analyst | ABA / autism services | $13.00 | 15 min | $52.00 | 1 |
| One-on-one ABA therapy by a technician | ABA / autism services | $14.88 | 15 min | $59.52 | 1 |
| Addiction (substance use) counseling | Behavioral health | $39.78 | 15 min | $100.28 | 2 |
| Assertive Community Treatment (ACT) team | Behavioral health | $166.70 | day | — | 2 |
| Behavioral health services (fee schedule) | Behavioral health | $200.97 | — | — | 2 |
| Comprehensive community support services | Behavioral health | $5.83 | 15 min | $23.32 | 8 |
| Crisis intervention (behavioral health) | Behavioral health | $51.34 | 15 min | $205.36 | 19 |
| Day treatment for children | Behavioral health | $10.39 | 15 min | $41.54 | 16 |
| Family support (behavioral health) | Behavioral health | $13.53 | 15 min | $54.12 | 21 |
| Intensive home-based treatment (IHBT) | Behavioral health | $348.18 | day | — | 2 |
| Intensive outpatient program (behavioral health) | Behavioral health | $51.88 | hour | $51.88 | 1 |
| Medically supervised inpatient withdrawal (per day) | Behavioral health | $241.08 | day | — | 2 |
| Medication training and support | Behavioral health | $12.71 | 15 min | $50.84 | 19 |
| Mental health assessment (non-physician) | Behavioral health | $81.14 | — | — | 45 |
| Mental health counseling | Behavioral health | $36.89 | 30 min | $53.64 | 2 |
| Mental health service plan development | Behavioral health | $44.43 | — | — | 14 |
| Multisystemic therapy for youth | Behavioral health | $309.56 | day | — | 1 |
| Opioid treatment program weekly bundle | Behavioral health | $213.03 | — | — | 5 |
| Outpatient psychotherapy and diagnostic evaluation | Behavioral health | $72.99 | — | $99.18 | 432 |
| Peer support (behavioral health) | Behavioral health | $8.75 | 15 min | $34.98 | 4 |
| Psychiatric partial hospitalization | Behavioral health | $53.64 | hour | $53.64 | 1 |
| Psychiatric residential treatment (daily) | Behavioral health | $525.00 | day | — | 3 |
| Psychosocial rehabilitation | Behavioral health | $7.33 | 15 min | $29.32 | 22 |
| Skills training and development | Behavioral health | $12.19 | 15 min | $48.76 | 23 |
| SUD inpatient rehabilitation (per day) | Behavioral health | $330.25 | day | — | 2 |
| SUD residential treatment (per day) | Behavioral health | $217.81 | day | — | 1 |
| Therapeutic behavioral services | Behavioral health | $14.55 | 15 min | $58.20 | 1 |
| Therapeutic foster care (child) | Behavioral health | $45.57 | day | — | 3 |
| FQHC / RHC visit (PPS or APM rate) | Clinics (FQHC/RHC) | $139.23 | — | — | 4 |
| Dental services | Dental | $203.38 | — | — | 1021 |
| Durable medical equipment | Equipment & supplies | $108.66 | — | $42.16 | 1021 |
| Enteral and parenteral nutrition | Equipment & supplies | $20.49 | per unit | — | 45 |
| Medical supplies | Equipment & supplies | $16.78 | per unit | — | 730 |
| Orthotics and prosthetics | Equipment & supplies | $359.60 | — | $47.40 | 622 |
| Adult day health (medical model) | Other home & community services | $15.00 | day | — | 3 |
| Adult day services | Other home & community services | $80.00 | day | — | 3 |
| Assistive technology assessment | Other home & community services | $300.00 | Per item | — | 3 |
| Case management / support coordination | Other home & community services | $30.75 | month | $123.00 | 18 |
| Chore services (heavy cleaning, yard work, pest control) | Other home & community services | $66.50 | per treatment | — | 5 |
| Emergency response system installation | Other home & community services | $30.00 | per unit | — | 4 |
| Emergency response system monitoring | Other home & community services | $30.00 | month | — | 4 |
| Family and peer mentoring | Other home & community services | $20.77 | hour | $20.77 | 1 |
| HCBS waiver service (other) | Other home & community services | $21.63 | day | — | 2 |
| Health care assessment (monthly, disability waiver) | Other home & community services | $7.50 | hour | $7.50 | 1 |
| Home modifications (accessibility) | Other home & community services | $17,500.00 | Lifetime | — | 2 |
| Home-delivered meals | Other home & community services | $7.40 | per unit | — | 1 |
| Nurse wellness counseling visit | Other home & community services | $20.77 | hour | $20.77 | 1 |
| Nursing assessment | Other home & community services | $176.00 | — | — | 5 |
| Prescribed pediatric extended care (medical day care) | Other home & community services | $529.75 | hour | $28.50 | 2 |
| Respite care (daily) | Other home & community services | $35.26 | day | — | 3 |
| Respite care (hourly) | Other home & community services | $6.25 | hour | $25.00 | 12 |
| Respite in a facility (daily) | Other home & community services | $200.08 | day | — | 6 |
| Vehicle modifications | Other home & community services | $600.00 | Per claim | — | 5 |
| Hospice continuous home care (hourly) | Hospice | $63.42 | hour | — | 50 |
| Hospice end-of-life visit add-on (per hour) | Hospice | $51.40 | per 15 min. units | — | 48 |
| Hospice general inpatient care (daily) | Hospice | $1,108.27 | — | — | 52 |
| Hospice inpatient respite (daily) | Hospice | $519.41 | day | — | 50 |
| Hospice routine home care (daily) | Hospice | $182.17 | day | — | 98 |
| Hospital administrative (non-acute) day | Hospital inpatient | $351.92 | daily rate | — | 2 |
| Inpatient DRG pricing input (outlier, cost ratio, stay) | Hospital inpatient | $44,000.00 | ratio | — | 1422 |
| Inpatient DRG relative weight | Hospital inpatient | $1.42 | — | — | 1356 |
| Inpatient hospital stay (DRG base rate) | Hospital inpatient | $13,550.90 | — | — | 62 |
| Inpatient hospital stay (per diem) | Hospital inpatient | $1,200.00 | day | — | 1 |
| Inpatient psychiatric stay (per day) | Hospital inpatient | $800.00 | per member per day | — | 2 |
| Outpatient hospital services (fee schedule) | Hospital outpatient | $40.02 | — | $35.11 | 23 |
| Behavior support services (disability waiver) | IDD services | $31.14 | 30 min | $62.28 | 4 |
| Community integration / community access (IDD) | IDD services | $41.63 | 1/2 day = 2-3 hrs | — | 3 |
| Day habilitation / day program (IDD) | IDD services | $36.46 | Half Day | — | 6 |
| ICF/IID stay (daily rate) | IDD services | $337.51 | day | — | 5 |
| IDD annual individual funding band (residential / ICF capitated band) | IDD services | $62,027.00 | year | — | 10 |
| In-home and community living supports (IDD) | IDD services | $21.49 | 15 min | $85.96 | 3 |
| Prevocational services | IDD services | $41.63 | 1/2 day = 2-3 hrs | — | 3 |
| Rate-model staff wage (component, not a billable fee) | IDD services | $9.18 | 15 min | — | 2 |
| Residential habilitation / group home supports | IDD services | $274.29 | day | — | 26 |
| Supported employment (job coaching) | IDD services | $21.95 | hour | — | 10 |
| Supported employment follow-along | IDD services | $27.90 | 15 min | $111.60 | 3 |
| Clinical lab tests | Lab & pathology | $14.22 | — | — | 6080 |
| Adult subacute nursing care (daily rate) | Nursing facility | $450.00 | per patient day | — | 1 |
| Nursing home ventilator care (daily rate) | Nursing facility | $708.00 | per Medicaid patient day | — | 1 |
| Swing-bed stay (hospital bed used for nursing-home care) | Nursing facility | $248.89 | daily rate | — | 1 |
| Directed payment: required minimum or maximum level | Other | $100.00 | % of Medicaid fee-for-service rate | — | 3 |
| Early intervention services for infants and toddlers | Other | $113.98 | 15 min | — | 9 |
| Managed care capitation rate | Other | $773.70 | month | — | 44 |
| Companion care | Personal care & attendant | $11.26 | hour | $13.65 | 7 |
| Personal care / attendant care (hourly) | Personal care & attendant | $6.25 | 15 min | $25.00 | 11 |
| Physician-administered drugs (J-codes) | Pharmacy | $36.34 | — | — | 9660 |
| Private duty nursing (hourly shifts) | Private duty nursing | $47.00 | hour | $47.00 | 7 |
| Waiver nursing (RN or LPN, by the 15 minutes) | Private duty nursing | $12.50 | 15 min | $50.00 | 3 |
| Physician and practitioner services (fee schedule) | Physician & professional | $225.37 | — | $61.16 | 132495 |
| Imaging and radiology | Radiology | $55.85 | — | — | 21189 |
| Cognitive rehabilitation therapy | Therapy (PT/OT/speech) | $14.96 | 15 min | $59.84 | 6 |
| Nutrition counseling (dietitian) | Therapy (PT/OT/speech) | $21.13 | 15 min | $84.52 | 32 |
| Occupational therapy | Therapy (PT/OT/speech) | $22.78 | 15 min | $91.12 | 21 |
| Occupational therapy evaluation | Therapy (PT/OT/speech) | $48.18 | — | — | 12 |
| Orthotic and prosthetic fitting and training | Therapy (PT/OT/speech) | $28.60 | 15 min | $114.40 | 24 |
| Other therapy services | Therapy (PT/OT/speech) | $61.68 | — | — | 1 |
| Physical therapy | Therapy (PT/OT/speech) | $21.61 | 15 min | $86.44 | 19 |
| Physical therapy evaluation | Therapy (PT/OT/speech) | $49.04 | — | — | 11 |
| Speech-generating device evaluation | Therapy (PT/OT/speech) | $74.34 | — | — | 10 |
| Speech-generating device therapy | Therapy (PT/OT/speech) | $61.88 | — | — | 10 |
| Speech-language evaluation | Therapy (PT/OT/speech) | $91.59 | — | — | 8 |
| Speech-language therapy | Therapy (PT/OT/speech) | $24.81 | — | — | 3 |
| Swallowing and feeding evaluation | Therapy (PT/OT/speech) | $52.01 | — | — | 10 |
| Swallowing and feeding therapy | Therapy (PT/OT/speech) | $51.72 | — | — | 8 |
| Air ambulance transport | Transportation | $1,747.24 | — | — | 2 |
| Ambulance extras (waiting time, extra attendant, neonatal) | Transportation | $37.71 | — | — | 5 |
| Ambulance mileage | Transportation | $5.99 | mile | — | 2 |
| Ground ambulance transport | Transportation | $174.86 | — | — | 3 |
| Eye exams and vision services | Vision & hearing | $34.24 | — | — | 4 |
| Eyeglasses and contact lenses | Vision & hearing | $15.12 | — | — | 210 |
| Hearing aids and hearing services | Vision & hearing | $58.20 | — | — | 18 |
Most-compared billing codes in South Carolina
Where South Carolina ranks among states for codes published widely. Rank 1 = highest rate.
| Code | Service | South Carolina | All-state median | Rank |
|---|---|---|---|---|
| 10005 | Physician and practitioner services (fee schedule) | $70.52 | $79.38 | 21 of 35 |
| 10006 | Physician and practitioner services (fee schedule) | $32.01 | $44.97 | 31 of 35 |
| 10007 | Physician and practitioner services (fee schedule) | $157.25 | $150.61 | 17 of 35 |
| 10008 | Physician and practitioner services (fee schedule) | $73.48 | $73.48 | 18 of 35 |
| 10009 | Physician and practitioner services (fee schedule) | $220.47 | $180.34 | 17 of 35 |
| 10010 | Physician and practitioner services (fee schedule) | $122.02 | $102.56 | 17 of 35 |
| 10021 | Physician and practitioner services (fee schedule) | $53.05 | $67.99 | 22 of 35 |
| 10030 | Physician and practitioner services (fee schedule) | $326.39 | $162.47 | 16 of 35 |
| 10060 | Physician and practitioner services (fee schedule) | $66.79 | $81.94 | 25 of 35 |
| 10061 | Physician and practitioner services (fee schedule) | $113.27 | $148.21 | 27 of 35 |
| 10080 | Physician and practitioner services (fee schedule) | $115.26 | $100.82 | 16 of 35 |
| 10081 | Physician and practitioner services (fee schedule) | $159.09 | $159.09 | 18 of 35 |
| 10120 | Physician and practitioner services (fee schedule) | $88.51 | $89.53 | 20 of 35 |
| 10121 | Physician and practitioner services (fee schedule) | $139.07 | $159.38 | 23 of 35 |
| 10140 | Physician and practitioner services (fee schedule) | $89.13 | $100.20 | 21 of 35 |
| 10160 | Physician and practitioner services (fee schedule) | $68.14 | $79.28 | 24 of 35 |
| 10180 | Physician and practitioner services (fee schedule) | $152.57 | $154.29 | 20 of 35 |
| 11000 | Physician and practitioner services (fee schedule) | $38.89 | $35.27 | 12 of 35 |
| 11001 | Physician and practitioner services (fee schedule) | $14.36 | $16.01 | 21 of 35 |
| 11004 | Physician and practitioner services (fee schedule) | $299.74 | $437.26 | 31 of 35 |
| 11005 | Physician and practitioner services (fee schedule) | $406.68 | $593.90 | 29 of 35 |
| 11006 | Physician and practitioner services (fee schedule) | $368.72 | $548.28 | 31 of 35 |
| 11008 | Physician and practitioner services (fee schedule) | $143.11 | $211.81 | 29 of 35 |
| 11010 | Physician and practitioner services (fee schedule) | $259.67 | $259.67 | 18 of 35 |
| 11011 | Physician and practitioner services (fee schedule) | $326.46 | $291.14 | 13 of 35 |
| 11012 | Physician and practitioner services (fee schedule) | $425.70 | $393.77 | 15 of 35 |
| 11042 | Physician and practitioner services (fee schedule) | $84.54 | $76.21 | 14 of 35 |
| 11043 | Physician and practitioner services (fee schedule) | $152.96 | $158.67 | 20 of 35 |
| 11044 | Physician and practitioner services (fee schedule) | $205.30 | $213.31 | 20 of 35 |
| 11055 | Physician and practitioner services (fee schedule) | $46.07 | $20.00 | 9 of 35 |
| 11056 | Physician and practitioner services (fee schedule) | $53.57 | $29.68 | 9 of 35 |
| 11057 | Physician and practitioner services (fee schedule) | $58.73 | $38.94 | 9 of 35 |
| 11102 | Physician and practitioner services (fee schedule) | $65.28 | $65.28 | 18 of 35 |
| 11103 | Physician and practitioner services (fee schedule) | $32.73 | $32.73 | 18 of 35 |
| 11104 | Physician and practitioner services (fee schedule) | $81.27 | $77.06 | 16 of 35 |
| 11105 | Physician and practitioner services (fee schedule) | $38.77 | $38.77 | 18 of 35 |
| 11106 | Physician and practitioner services (fee schedule) | $100.89 | $95.36 | 15 of 35 |
| 11107 | Physician and practitioner services (fee schedule) | $46.36 | $46.36 | 18 of 35 |
| 11300 | Physician and practitioner services (fee schedule) | $52.13 | $42.15 | 14 of 35 |
| 11301 | Physician and practitioner services (fee schedule) | $63.26 | $55.47 | 15 of 35 |
Managed care in South Carolina
13 plans on record, 3 state-directed payment records, 124 published capitation cells.
Who sets the rate, line by line →Recent rate changes and notices
Frequently asked questions
Where does South Carolina publish its Medicaid fee schedules?
South Carolina publishes rates across 46 official documents (fee schedules, rate notices and bulletins). Every rate on this page links to its source document.
How many Medicaid rates does South Carolina publish?
177,358 rates are current across 119 services and 8 programs, with 179,707 versions on record since 2003-10-16.
Do South Carolina Medicaid managed-care plans pay the fee schedule?
For 0 of 15 service lines, plan contracts or state law set a rule plans must follow (a floor, a state-set rate or a required pass-through). For the rest, plans negotiate. See the managed-care page for each line's rule and citation.
Other states
Your South Carolina rate cardYour codes, what South Carolina pays, what plans must pay, and every change in 2026.