BT vs RBT: what a behavior technician needs in South Carolina

Only in some situations. See the detail below.

As of 2026-10-21, for SC Medicaid only: per the July 2026 SCDHHS ASD provider training, a BT may deliver services without RBT credentialing for a one-time 90-day period measured from the time of hire (not from the first date of providing services to Medicaid members). The clock is not reset, and BT delivery is limited to clinic settings with an onsite BCaBA/BCBA/BCBA-D. Home and school-based services are delivered by an RBT (or credentialed analyst) in approved settings. The July training also addresses recoupment (details not captured here). Billing under the enrolled BCBA/BCaBA, with RBTs unable to enroll or bill independently, comes from the original draft and was not re-verified by the checker. Commercial-payer and non-Medicaid rules were not researched. The provider manual's wording differs from the July training on the clock start and on the credentials listed for home/school delivery, so confirm with SCDHHS.

• Medicaid-specific: age 18+ with high school diploma or equivalent (SCDHHS ASD manual; supported by July 2026 training)
• Medicaid-specific: provider groups must keep a file for each provider including a criminal record check from SLED, updated annually (draft wording from SCDHHS ASD manual; the provider FAQ confirms an annual criminal background check; final-manual wording not verified)
• Medicaid-specific: evidence of child abuse registry checks and state/national sex offender registry checks before start of employment and annually thereafter, with no findings/charges (draft wording from SCDHHS ASD manual; final-manual wording not verified)

Enroll and bill as a licensed independent practitioner (licensed psychologist, LPES, LISW-CP, LMFT, or LPC) or as a BACB-certified BCBA-D, BCBA, or BCaBA in good standing, located in the South Carolina Medicaid Service Area except as required by 42 CFR 431.52, under a written SCDHHS participation agreement. Enrollment is high-risk: fingerprint-based criminal background checks with SLED and the FBI for individual ASD providers, pre-enrollment site visit, and 100% ownership disclosure (42 CFR Part 455 Subpart E and 42 CFR 455.102). S.C. Code Ann. § 40-75-290, as cited in the manual, exempts state-agency providers, school-district mental-health counselors, and entities acting for a state agency. ABA treatment (97153 and related codes) is furnished by a BCBA-D, BCBA, BCaBA, RBT, or behavior technician (BT) within BACB competency. BCaBAs, RBTs, and BTs are not separately enrolled; they render under the direct supervision of an enrolled ABA provider and the RBT/BT must bill under that BCBA-D, BCBA, or BCaBA NPI. 97151 (behavior identification assessment) is in person by a BCBA-D, BCBA, or BCaBA. 97152 is by an RBT under direction of a physician or other qualified provider (RBTs cannot do this independently in school). 0362T and 0373T require the physician, BCBA-D, BCBA, or BCaBA on site (immediately available and interruptible) with two or more technicians. 97153 may be administered by a BCBA-D, BCBA, BCaBA, RBT, or BT; home and school 97153 must be an RBT, BCaBA, BCBA, or BCBA-D. 97154 is group treatment administered by an RBT under a BCBA-D, BCBA, or BCaBA. 97155, 97156, 97157, and 97158 are administered by a BCBA-D, BCBA, or BCaBA (97155 in person with the member; 97156 may use telehealth with GT). LIPs bill non-ABA ASD treatment (H2019), not technician ABA. RBT: age 18 or older, high-school diploma or national equivalent, 40 hours of training, RBT Competency Assessment, and RBT exam. BT: age 18 or older and high-school diploma or national equivalent. MCO members: provider must be credentialed and contracted with the member’s MCO; the MCO handles authorization, coverage, and reimbursement.

It depends. See the condition below.

An RBT credential is required for technician-level ABA. A BT gets one one-time 90-day grace period to obtain the RBT credential, starting on the date of the first ABA service the BT renders to their first Medicaid member (manual qualification table; the supervision section says the first service rendered by the BT to any Medicaid member). The 90 days do not reset if employment, office, group, supervisor, or patient changes, or if the credential is not obtained. During the grace period an uncredentialed BT may deliver ABA only in a practice-based/clinic setting while a BCaBA, BCBA, or BCBA-D is physically on site and available to intervene. Home and school 97153 cannot be delivered by an uncredentialed BT. Services after day 90 without an RBT credential are subject to post-payment review and recoupment from the enrolled provider and/or group. The enrolled provider must keep a file on the grace-period outcome. When a BT signs the clinical service note, the signature line must include the date the 90-day period began. The supervising BCBA or BCaBA remains responsible for continuity of care if the technician does not become an RBT within 90 days.