<html> <head> <title>Rule 67:16:02:01 Definitions.</title> <META NAME="Keywords" Content="Administrative Rules 67:16:02:01"> <META NAME="Description" Content="Administrative Rules 67:16:02:01 Definitions."> <meta http-equiv=Content-Type content="text/html; charset=windows-1252"> <meta name=Generator content="Microsoft Word 15 (filtered)"> <style> <!-- /* Font Definitions */ @font-face {font-family:"Cambria Math"; panose-1:2 4 5 3 5 4 6 3 2 4;} @font-face {font-family:Times; panose-1:2 2 6 3 5 4 5 2 3 4;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {margin:0in; margin-bottom:.0001pt; font-size:10.0pt; font-family:"Times",serif; color:black;} p.MsoBodyText, li.MsoBodyText, div.MsoBodyText {mso-style-link:"Body Text Char"; margin:0in; margin-bottom:.0001pt; text-align:justify; font-size:12.0pt; font-family:"Times New Roman",serif; color:black;} a:link, span.MsoHyperlink {color:blue; text-decoration:underline;} a:visited, span.MsoHyperlinkFollowed {color:#954F72; text-decoration:underline;} span.BodyTextChar {mso-style-name:"Body Text Char"; mso-style-link:"Body Text"; font-family:"Times New Roman",serif;} .MsoChpDefault {font-size:10.0pt; color:black;} @page WordSection1 {size:8.5in 11.0in; margin:1.0in 1.25in 1.0in 1.25in;} div.WordSection1 {page:WordSection1;} --> </style> </head> <body lang=EN-US link=blue vlink="#954F72"> <div class=WordSection1> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>67:16:02:01.&nbsp;&nbsp;Definitions.</b> Terms used in this chapter mean:</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (1)&nbsp;&nbsp;&quot;Clinical nurse specialist,&quot; an individual who is licensed under SDCL <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=36-9-85">36-9-85</A> to perform the functions contained in SDCL 36-9-87</span><span style='font-size: 12.0pt;font-family:"Times New Roman",serif'>, or an individual licensed or certified in another state to perform those functions</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoBodyText>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (2)&nbsp;&nbsp;&quot;Medical and other health services,&quot; any of the items or services covered in this chapter under the sections on physician's and other health services;</p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (3)&nbsp;&nbsp;&quot;Nurse anesthetist,&quot; an individual who is qualified under SDCL <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=36-9-30.1">36-9-30.1</A> to perform the functions contained in SDCL 36-9-3.1, or an individual licensed or certified in another state to perform those functions;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (4)&nbsp;&nbsp;&quot;Nurse midwife,&quot; an individual who is qualified under SDCL chapter <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=36-9A">36-9A</A> to perform the functions contained in SDCL 36-9A-13, or an individual licensed or certified in another state to perform those functions;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (5)&nbsp;&nbsp;&quot;Nurse practitioner,&quot; an individual who is qualified under SDCL chapter <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=36-9A">36-9A</A> to perform the functions contained in SDCL 36-9A-12</span><span style='font-size: 12.0pt;font-family:"Times New Roman",serif'>, or an individual licensed or certified in another state to perform those functions</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (6)&nbsp;&nbsp;&quot;Physician,&quot; a person licensed as a physician in accordance with the provisions of SDCL chapter <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=36-4">36-4</A> 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;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (7)&nbsp;&nbsp;&quot;Physician assistant,&quot; an individual qualified and certified under the provisions of SDCL chapter <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=36-4A">36-4A</A></span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> to perform the functions contained in SDCL 36-4A-26.l, or an individual licensed or certified in another state to perform those functions</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (8)&nbsp;&nbsp;&quot;Postoperative management only,&quot; performance of postoperative management by one physician</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> or other licensed practitioner</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> after another physician</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> </span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>or other licensed practitioner has performed the surgical procedure;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (9)&nbsp;&nbsp;&quot;Preoperative management only,&quot; performance of preoperative care and evaluation by one physician</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> </span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>or other licensed practitioner before another physician or other licensed practitioner</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> </span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>performs the surgical procedure;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (10)&nbsp;&nbsp;&quot;Procedure codes,&quot; identifying numbers used in the submission of claims for medical, surgical, and diagnostic services;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (11)&nbsp;&nbsp;&quot;Reduced services,&quot; </span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>an</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> instance in which a service or procedure is partially reduced or eliminated at the physician</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> </span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>or other licensed practitioner</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>'s</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> request;</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> and</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (12)&nbsp;&nbsp;&quot;Unusual services,&quot; </span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>an instance in</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> which the service provided is greater than that usually required for the procedure.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>Source:</b> SL 1975, ch 16, &#167;&nbsp;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.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>General Authority:</b> SDCL <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=28-6-1">28-6-1(1).</A></span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>Law Implemented:</b> SDCL <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=28-6-1">28-6-1(1)</A></span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>(2)</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> </div> </body> </html>