<html xmlns="http://www.w3.org/1999/xhtml"><head><meta charset="UTF-8" /><title></title><meta name="Generator" content="PowerTools for Open XML" /><style>span { white-space: pre-wrap; } p.s454f6c95-981a-4f56-98dd-63ad22d07e3fP0 { margin-top: 0; margin-bottom: 0; margin-left: 0; margin-right: 0; text-indent: 0.00in; text-align: justify; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; line-height: 108%; } span.s454f6c95-981a-4f56-98dd-63ad22d07e3fC0 { color: #000000; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.s454f6c95-981a-4f56-98dd-63ad22d07e3fC0-000000 { color: #0000FF; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.s454f6c95-981a-4f56-98dd-63ad22d07e3fC0-000001 { color: #000000; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.s454f6c95-981a-4f56-98dd-63ad22d07e3fC0-000002 { color: #0000FF; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.s454f6c95-981a-4f56-98dd-63ad22d07e3f000003 { color: #000000; background: white; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } </style></head><body><div><p dir="ltr" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fP0"><span xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">    </span><a href="https://sdlegislature.gov/Rules?Rule=67:16:02:03"><span class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0-000000">67:16:02:03</span></a><span class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0-000001">.  Rate of payment.</span><span xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0"> When computing the rate of reimbursement, the department uses the fee schedules established under the provisions of § </span><a href="https://sdlegislature.gov/Rules?Rule=67:16:02:01.01"><span class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0-000002">67:16:02:01.01</span></a><span class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">. A claim submitted under this chapter must be submitted at the p</span><span class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">rovider</span><span class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">'s usual and customary charge. Payment is limited to the lesser of the p</span><span class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">rovider</span><span class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">'s usual and customary charge or the payment established under the following provisions:</span></p><p dir="ltr" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fP0"><span xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3f000003"> </span></p><p dir="ltr" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fP0"><span xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">    (1)  For nonlaboratory procedures listed in the applicable fee schedule, the amount specified in the fee schedule;</span></p><p dir="ltr" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fP0"><span xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3f000003"> </span></p><p dir="ltr" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fP0"><span xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">    (2)  </span><span class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">If no fee is specified for</span><span xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0"> nonlaboratory procedures,</span><span xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0"> payment is limited to forty</span><span xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0"> percent of the usual and customary charge;</span></p><p dir="ltr" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fP0"><span xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3f000003"> </span></p><p dir="ltr" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fP0"><span xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">    (3)  For laboratory procedures listed in the applicable fee schedule, the amount specified in the fee schedule;</span></p><p dir="ltr" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fP0"><span xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3f000003"> </span></p><p dir="ltr" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fP0"><span xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">    (4)  </span><span class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">If no fee is specified for</span><span xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0"> laboratory procedures, </span><span class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">payment is limited to sixty</span><span xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0"> percent of the p</span><span class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">rovider</span><span class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">'s usual and customary charge;</span></p><p dir="ltr" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fP0"><span xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3f000003"> </span></p><p dir="ltr" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fP0"><span xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">    (5)  For anesthesia services furnished by a physician, the fee established in the fee schedule on the department's fee schedule website. Time must be reported in </span><span class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">fifteen</span><span class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">-minute units beginning from the time the physician begins to prepare the patient for induction and ending when the patient is placed under postoperative supervision and the physician is no longer in personal attendance;</span></p><p dir="ltr" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fP0"><span xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3f000003"> </span></p><p dir="ltr" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fP0"><span xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">    (6)  For anesthesia services furnished by a nurse anesthetist, the fee established in the fee schedule on the department's fee schedule website, computed according to subdivision (5) of this section </span><span xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">for </span><span class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">as long as the anesthetist is assisting the physician in the care of the patient;</span></p><p dir="ltr" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fP0"><span xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3f000003"> </span></p><p dir="ltr" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fP0"><span xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">    (7)  For medical supplies incidental to the professional service provided, the fee established in the nonlaboratory fee schedule. If </span><span class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">no</span><span xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0"> fee is </span><span class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">specified for the medical supplies, payment is limited to ninety p</span><span xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">ercent of the </span><span xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">lesser of the </span><span class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">p</span><span class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">rovider</span><span class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">'s usual and customary charge</span><span xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0"> or the manufacturer's suggested retail price</span><span class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">;</span></p><p dir="ltr" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fP0"><span xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3f000003"> </span></p><p dir="ltr" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fP0"><span xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">    (8)  For injection and immunization procedures, the amount established in the nonlaboratory fee schedule. If </span><span class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">no fee is specified</span><span class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">,</span><span xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0"> payment is limited to forty</span><span xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0"> percent of the p</span><span class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">rovider</span><span class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">'s usual and customary charge; and</span></p><p dir="ltr" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fP0"><span xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3f000003"> </span></p><p dir="ltr" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fP0"><span xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">    (9)  For prosthetic or orthotic devices or medical equipment provided by a physician, the fee established in the nonlaboratory fee schedule. If </span><span class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">no</span><span xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0"> fee is </span><span class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">specified</span><span class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">,</span><span xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0"> payment is limited to seventy-five</span><span xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0"> percent of the</span><span xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0"> lesser of the</span><span xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0"> p</span><span class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">rovider</span><span class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">'s usual and customary charge</span><span xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0"> or the manufacturer's suggested retail price</span><span class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">.</span></p><p dir="ltr" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fP0"><span xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3f000003"> </span></p><p dir="ltr" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fP0"><span xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">    </span><span class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0-000001">Source:</span><span xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0"> SL 1975, ch 16, § 1; 7 SDR 66, 7 SDR 89, effective July 1, 1981; 16 SDR 64, effective October 8, 1989; 16 SDR 214, effective June 11, 1990; 16 SDR 234, effective July 2, 1990; 17 SDR 200, effective July 1, 1991; 18 SDR 78, effective November 4, 1991; 18 SDR 107, effective December 29, 1991; 20 SDR 28, effective August 31, 1993; 26 SDR 168, effective July 1, 2000; 34 SDR 68, effective September 12, 2007; 37 SDR 236, effective June 28, 2011; 37 SDR 236, adopted June 8, 2011, effective July 1, 2012; 40 SDR 229, effective June 30, 2014; 42 SDR 51, effective October 13, 2015; 44 SDR 94, effective December 4, 2017</span><span class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">; 50 SDR 63, effective November 27, 2023</span><span class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">.</span></p><p dir="ltr" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fP0"><span xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">    </span><span class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0-000001">General Authority:</span><span xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0"> SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=28-6-1"><span class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0-000002">28-6-1</span></a><span class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">.</span></p><p dir="ltr" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fP0"><span xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">    </span><span class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0-000001">Law Implemented:</span><span xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0"> SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=28-6-1"><span class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0-000002">28-6-1</span></a><span xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">, </span><a href="https://sdlegislature.gov/Statutes?Statute=28-6-1"><span class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0-000002">28-6-1</span></a><span class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">.1</span><span class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">.</span></p><p dir="ltr" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fP0"><span xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3f000003"> </span></p></div></body></html>