Terms and Conditions for Delivery of Services
Reimbursement Rates, Authorized Equipment & Supplies, and Fee Schedules
- General information about reimbursement rates (pdf)
- List of durable medical equipment (DME) and medical supplies authorized for purchase (pdf)
- Physician fee schedule (pdf)
- Pediatric subspecialty fee schedule (pdf)
- Hearing Services fee schedule (pdf)
- Orthodontic fee schedule (pdf)
- Dental fee schedule (pdf)
- Orthotics and prosthetics fee schedule (maximum) (pdf)
- Hospital fee schedule (inpatient and outpatient) (pdf)
Forms
- Authorization Form (DHEC 0727) (pdf)
- Request for Orthodontic Services (DHEC 0762) (pdf)
- Orthodontist Plan of Care (DHEC 0911) (pdf)