<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.s63bace03-ed09-4a4a-9d82-4218bf702480P0 { 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.s63bace03-ed09-4a4a-9d82-4218bf702480C0 { color: black; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.s63bace03-ed09-4a4a-9d82-4218bf702480C0-000000 { color: #0000FF; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.s63bace03-ed09-4a4a-9d82-4218bf702480C0-000001 { color: black; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.s63bace03-ed09-4a4a-9d82-4218bf702480000002 { color: black; background: white; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.s63bace03-ed09-4a4a-9d82-4218bf702480C0-000003 { color: #0000FF; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.s63bace03-ed09-4a4a-9d82-4218bf702480C2 { color: #0000FF; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; text-decoration: underline; font-style: normal; font-weight: normal; margin: 0; padding: 0; } </style></head><body><div><p dir="ltr" class="s63bace03-ed09-4a4a-9d82-4218bf702480P0"><span xml:space="preserve" class="s63bace03-ed09-4a4a-9d82-4218bf702480C0">    </span><a href="https://sdlegislature.gov/Rules?Rule=67:16:03:14"><span class="s63bace03-ed09-4a4a-9d82-4218bf702480C0-000000">67:16:03:14</span></a><span class="s63bace03-ed09-4a4a-9d82-4218bf702480C0-000001">.  Claim requirements.</span><span xml:space="preserve" class="s63bace03-ed09-4a4a-9d82-4218bf702480C0"> A claim for services provided under this chapter must be submitted at the hospital's usual and customary charge to the general public and must comply with the informational requirements established in the </span><span class="s63bace03-ed09-4a4a-9d82-4218bf702480C0-000001">Official UB-04 Data Specifications Manual 20</span><span class="s63bace03-ed09-4a4a-9d82-4218bf702480C0-000001">23</span><span class="s63bace03-ed09-4a4a-9d82-4218bf702480C0">.</span></p><p dir="ltr" class="s63bace03-ed09-4a4a-9d82-4218bf702480P0"><span xml:space="preserve" class="s63bace03-ed09-4a4a-9d82-4218bf702480000002"> </span></p><p dir="ltr" class="s63bace03-ed09-4a4a-9d82-4218bf702480P0"><span xml:space="preserve" class="s63bace03-ed09-4a4a-9d82-4218bf702480C0">    Claims for outpatient laboratory services must contain the applicable procedure codes from the </span><span class="s63bace03-ed09-4a4a-9d82-4218bf702480C0-000001">Current Procedural Terminology</span><span xml:space="preserve" class="s63bace03-ed09-4a4a-9d82-4218bf702480C0"> adopted in § </span><a href="https://sdlegislature.gov/Rules?Rule=67:16:01:25"><span class="s63bace03-ed09-4a4a-9d82-4218bf702480C0-000003">67:16:01:25</span></a><span class="s63bace03-ed09-4a4a-9d82-4218bf702480C0">.</span></p><p dir="ltr" class="s63bace03-ed09-4a4a-9d82-4218bf702480P0"><span xml:space="preserve" class="s63bace03-ed09-4a4a-9d82-4218bf702480000002"> </span></p><p dir="ltr" class="s63bace03-ed09-4a4a-9d82-4218bf702480P0"><span xml:space="preserve" class="s63bace03-ed09-4a4a-9d82-4218bf702480C0">    </span><span class="s63bace03-ed09-4a4a-9d82-4218bf702480C0-000001">Source:</span><span xml:space="preserve" class="s63bace03-ed09-4a4a-9d82-4218bf702480C0"> 16 SDR 235, effective July 5, 1990; 17 SDR 4, effective July 16, 1990; 17 SDR 180, effective May 27, 1991; 18 SDR 78, effective November 4, 1991; 19 SDR 26, effective August 23, 1992; 19 SDR 165, effective May 3, 1993; 20 SDR 149, effective March 21, 1994; 21 SDR 183, effective April 30, 1995; 22 SDR 143, effective May 9, 1996; 23 SDR 232, effective July 10, 1997; 24 SDR 86, effective January 1, 1998; 24 SDR 144, effective April 30, 1998; 25 SDR 116, effective March 24, 1999; 26 SDR 157, effective June 7, 2000; 28 SDR 1, effective July 18, 2001; 31 SDR 39, effective September 29, 2004; 42 SDR 51, effective October 13, 2015</span><span class="s63bace03-ed09-4a4a-9d82-4218bf702480C0">; 47 SDR 38, effective October 6, 2020</span><span class="s63bace03-ed09-4a4a-9d82-4218bf702480C0">; 49 SDR 21, effective September 12, 2022</span><span class="s63bace03-ed09-4a4a-9d82-4218bf702480C0">.</span></p><p dir="ltr" class="s63bace03-ed09-4a4a-9d82-4218bf702480P0"><span xml:space="preserve" class="s63bace03-ed09-4a4a-9d82-4218bf702480C0">    </span><span class="s63bace03-ed09-4a4a-9d82-4218bf702480C0-000001">General Authority:</span><span xml:space="preserve" class="s63bace03-ed09-4a4a-9d82-4218bf702480C0"> SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=28-6-1"><span class="s63bace03-ed09-4a4a-9d82-4218bf702480C0-000003">28-6-1</span></a><span class="s63bace03-ed09-4a4a-9d82-4218bf702480C0">.</span></p><p dir="ltr" class="s63bace03-ed09-4a4a-9d82-4218bf702480P0"><span xml:space="preserve" class="s63bace03-ed09-4a4a-9d82-4218bf702480C0">    </span><span class="s63bace03-ed09-4a4a-9d82-4218bf702480C0-000001">Law Implemented:</span><span xml:space="preserve" class="s63bace03-ed09-4a4a-9d82-4218bf702480C0"> SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=28-6-1"><span class="s63bace03-ed09-4a4a-9d82-4218bf702480C0-000003">28-6-1</span></a><span class="s63bace03-ed09-4a4a-9d82-4218bf702480C0">(4).</span></p><p dir="ltr" class="s63bace03-ed09-4a4a-9d82-4218bf702480P0"><span xml:space="preserve" class="s63bace03-ed09-4a4a-9d82-4218bf702480000002"> </span></p><p dir="ltr" class="s63bace03-ed09-4a4a-9d82-4218bf702480P0"><span xml:space="preserve" class="s63bace03-ed09-4a4a-9d82-4218bf702480C0">    </span><span class="s63bace03-ed09-4a4a-9d82-4218bf702480C0-000001">Reference:</span><span xml:space="preserve" class="s63bace03-ed09-4a4a-9d82-4218bf702480C0"> </span><span class="s63bace03-ed09-4a4a-9d82-4218bf702480C0-000001">Official UB-04 Data Specifications Manual 20</span><span class="s63bace03-ed09-4a4a-9d82-4218bf702480C0-000001">23</span><span xml:space="preserve" class="s63bace03-ed09-4a4a-9d82-4218bf702480C0">, </span><span class="s63bace03-ed09-4a4a-9d82-4218bf702480C2">https://www.nubc.org/ub-04-products</span><span class="s63bace03-ed09-4a4a-9d82-4218bf702480C0">; $165.00</span><span class="s63bace03-ed09-4a4a-9d82-4218bf702480C0">.</span></p><p dir="ltr" class="s63bace03-ed09-4a4a-9d82-4218bf702480P0"><span xml:space="preserve" class="s63bace03-ed09-4a4a-9d82-4218bf702480000002"> </span></p><p dir="ltr" class="s63bace03-ed09-4a4a-9d82-4218bf702480P0"><span xml:space="preserve" class="s63bace03-ed09-4a4a-9d82-4218bf702480C0">    </span><span class="s63bace03-ed09-4a4a-9d82-4218bf702480C0-000001">Cross-Reference:</span><span xml:space="preserve" class="s63bace03-ed09-4a4a-9d82-4218bf702480C0"> Claims, ch </span><a href="https://sdlegislature.gov/Rules?Rule=67:16:35"><span class="s63bace03-ed09-4a4a-9d82-4218bf702480C0-000003">67:16:35</span></a><span class="s63bace03-ed09-4a4a-9d82-4218bf702480C0">.</span></p><p dir="ltr" class="s63bace03-ed09-4a4a-9d82-4218bf702480P0"><span xml:space="preserve" class="s63bace03-ed09-4a4a-9d82-4218bf702480000002"> </span></p></div></body></html>