67:16:02:01. Definitions. Terms used in this chapter mean:
(1) "Clinical nurse specialist," an individual who is licensed under SDCL 36-9-85 to perform the functions contained in SDCL 36-9-87, or an individual licensed or certified in another state to perform those functions;
(2) "Medical and other health services," any of the items or services covered in this chapter under the sections on physician's and other health services;
(3) "Nurse anesthetist," an individual who is qualified under SDCL 36-9-30.1 to perform the functions contained in SDCL 36-9-3.1, or an individual licensed or certified in another state to perform those functions;
(4) "Nurse midwife," an individual who is qualified under SDCL chapter 36-9A to perform the functions contained in SDCL 36-9A-13, or an individual licensed or certified in another state to perform those functions;
(5) "Nurse practitioner," an individual who is qualified under SDCL chapter 36-9A to perform the functions contained in SDCL 36-9A-12, or an individual licensed or certified in another state to perform those functions;
(6) "Physician," a person licensed as a physician in accordance with the provisions of SDCL chapter 36-4 and qualified to provide medical and other health services under this chapter, or an individual licensed or certified in another state to perform those functions;
(7) "Physician assistant," an individual qualified and certified under the provisions of SDCL chapter 36-4A to perform the functions contained in SDCL 36-4A-26.l, or an individual licensed or certified in another state to perform those functions;
(8) "Postoperative management only," performance of postoperative management by one physician or other licensed practitioner after another physician or other licensed practitioner has performed the surgical procedure;
(9) "Preoperative management only," performance of preoperative care and evaluation by one physician or other licensed practitioner before another physician or other licensed practitioner performs the surgical procedure;
(10) "Procedure codes," identifying numbers used in the submission of claims for medical, surgical, and diagnostic services;
(11) "Reduced services," an instance in which a service or procedure is partially reduced or eliminated at the physician or other licensed practitioner's request; and
(12) "Unusual services," an instance in which the service provided is greater than that usually required for the procedure.
Source: SL 1975, ch 16, § 1; 7 SDR 66, 7 SDR 89, effective July 1, 1981; 16 SDR 64, effective October 8, 1989; 16 SDR 234, effective July 2, 1990; 18 SDR 50, effective September 15, 1991; 19 SDR 165, effective May 3, 1993; 24 SDR 86, effective January 1, 1998; 34 SDR 68, effective September 12, 2007; 44 SDR 94, effective December 4, 2017.
General Authority: SDCL 28-6-1(1).
Law Implemented: SDCL 28-6-1(1)(2).
67:16:02:01.01. Fee schedules for physician services. Fee schedules for services provided under this chapter are available on the department's fee schedule website. When computing the rate of reimbursement for physician services, the department uses the following fee schedules:
(1) Nonlaboratory fee schedule; and
(2) Laboratory fee schedule.
The fee schedules are subject to review and amendment by the department. A provider may request that the department review a particular reimbursement rate for possible adjustment or request the inclusion or exclusion of a particular code from the list. When reviewing the requests, the department shall review paid claims information, Medicare fee schedules, national coding lists, and documentation submitted by the provider or the associated medical professional organization to determine whether a change is warranted.
Source: 34 SDR 68, effective September 12, 2007; 42 SDR 51, effective October 13, 2015; 44 SDR 94, effective December 4, 2017.
General Authority: SDCL 28-6-1(1)(2).
Law Implemented: SDCL 28-6-1(1)(2), 28-6-1.1.
