MedicaidBilling CodesMedium impact
Audiology Services Policy Updates
SC Medicaid - SCDHHS·SC · ENT (Ear, Nose & Throat)·Provider Communication
Effective date
Jan 1, 2026
We identified it
Jun 18, 2026
Summary
South Carolina Medicaid is adding coverage for new audiology CPT codes effective January 1, 2026, including hearing aid selection, fitting, follow-up services, and bone-anchored implant programming. The policy establishes specific billing limitations, frequency restrictions, and reimbursement rates for these services.
Action Required
Before January 1, 2026: Billing team must add new audiology CPT codes 92631-92641, V5014, 92622, and 92623 to billing system with specific frequency limitations and same-day billing restrictions. Update fee schedules with provided reimbursement rates. Configure system to enforce 12-month limits and daily restrictions as specified in the policy. Failure to properly configure restrictions may result in claim denials.