<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.s4df2a81c-023a-417c-8a5a-fdf627208fceP0 { 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.s4df2a81c-023a-417c-8a5a-fdf627208fceC0 { color: black; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.s4df2a81c-023a-417c-8a5a-fdf627208fceC0-000000 { color: #0000FF; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.s4df2a81c-023a-417c-8a5a-fdf627208fceC0-000001 { color: black; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.s4df2a81c-023a-417c-8a5a-fdf627208fce000002 { color: black; background: white; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.s4df2a81c-023a-417c-8a5a-fdf627208fceC0-000003 { color: #0000FF; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } </style></head><body><div><p dir="ltr" class="s4df2a81c-023a-417c-8a5a-fdf627208fceP0"><span xml:space="preserve" class="s4df2a81c-023a-417c-8a5a-fdf627208fceC0">    </span><a href="https://sdlegislature.gov/Rules?Rule=67:16:07:05"><span class="s4df2a81c-023a-417c-8a5a-fdf627208fceC0-000000">67:16:07:05</span></a><span class="s4df2a81c-023a-417c-8a5a-fdf627208fceC0-000001">.  Rate of payment.</span><span xml:space="preserve" class="s4df2a81c-023a-417c-8a5a-fdf627208fceC0"> A claim submitted under this chapter must be submitted at the podiatrist's usual and customary charge. Except for bilateral or multiple surgeries, payment is limited to the lesser of the provider's usual and customary charge or the fee </span><span class="s4df2a81c-023a-417c-8a5a-fdf627208fceC0">listed</span><span xml:space="preserve" class="s4df2a81c-023a-417c-8a5a-fdf627208fceC0"> on the department's website. If no fee is listed, payment is limited to </span><span class="s4df2a81c-023a-417c-8a5a-fdf627208fceC0">40 percent</span><span xml:space="preserve" class="s4df2a81c-023a-417c-8a5a-fdf627208fceC0"> of the provider's usual and customary charge. The maximum rate of payment for covered podiatry services is available on the department's fee schedule website</span><span class="s4df2a81c-023a-417c-8a5a-fdf627208fceC0">.</span></p><p dir="ltr" class="s4df2a81c-023a-417c-8a5a-fdf627208fceP0"><span xml:space="preserve" class="s4df2a81c-023a-417c-8a5a-fdf627208fce000002"> </span></p><p dir="ltr" class="s4df2a81c-023a-417c-8a5a-fdf627208fceP0"><span xml:space="preserve" class="s4df2a81c-023a-417c-8a5a-fdf627208fceC0">    If a provider performs bilateral or multiple surgeries during the same operating session, the department </span><span class="s4df2a81c-023a-417c-8a5a-fdf627208fceC0">must follow</span><span xml:space="preserve" class="s4df2a81c-023a-417c-8a5a-fdf627208fceC0"> the payment methodology established in chapter </span><a href="https://sdlegislature.gov/Rules?Rule=67:16:02"><span class="s4df2a81c-023a-417c-8a5a-fdf627208fceC0-000003">67:16:02</span></a><span class="s4df2a81c-023a-417c-8a5a-fdf627208fceC0">.</span></p><p dir="ltr" class="s4df2a81c-023a-417c-8a5a-fdf627208fceP0"><span xml:space="preserve" class="s4df2a81c-023a-417c-8a5a-fdf627208fce000002"> </span></p><p dir="ltr" class="s4df2a81c-023a-417c-8a5a-fdf627208fceP0"><span xml:space="preserve" class="s4df2a81c-023a-417c-8a5a-fdf627208fceC0">    A provider may request that the rate of payment be amended. The request must be in writing and directed to the department's state Medicaid director. The provider </span><span class="s4df2a81c-023a-417c-8a5a-fdf627208fceC0">shall</span><span xml:space="preserve" class="s4df2a81c-023a-417c-8a5a-fdf627208fceC0"> specify the reason for the requested change. The department shall review the request and determine whether the rate change is warranted and </span><span xml:space="preserve" class="s4df2a81c-023a-417c-8a5a-fdf627208fceC0">whether </span><span xml:space="preserve" class="s4df2a81c-023a-417c-8a5a-fdf627208fceC0">there is sufficient revenue to cover the </span><span class="s4df2a81c-023a-417c-8a5a-fdf627208fceC0">change</span><span class="s4df2a81c-023a-417c-8a5a-fdf627208fceC0">. When the department takes final action on the requested change, the department shall notify the podiatrist who requested the change. A change in a payment rate is reflected on the department's fee schedule website.</span></p><p dir="ltr" class="s4df2a81c-023a-417c-8a5a-fdf627208fceP0"><span xml:space="preserve" class="s4df2a81c-023a-417c-8a5a-fdf627208fce000002"> </span></p><p dir="ltr" class="s4df2a81c-023a-417c-8a5a-fdf627208fceP0"><span xml:space="preserve" class="s4df2a81c-023a-417c-8a5a-fdf627208fceC0">    </span><span class="s4df2a81c-023a-417c-8a5a-fdf627208fceC0-000001">Source:</span><span xml:space="preserve" class="s4df2a81c-023a-417c-8a5a-fdf627208fceC0"> 1 SDR 30, effective October 13, 1974; repealed, 3 SDR 26, effective October 6, 1976; readopted, 16 SDR 114, effective January 15, 1990; 16 SDR 227, effective June 25, 1990; 20 SDR 135, effective February 22, 1994; 33 SDR 125, effective January 31, 2007; 42 SDR 51, effective October 13, 2015</span><span class="s4df2a81c-023a-417c-8a5a-fdf627208fceC0">; 49 SDR 21, effective September 12, 2022</span><span class="s4df2a81c-023a-417c-8a5a-fdf627208fceC0">.</span></p><p dir="ltr" class="s4df2a81c-023a-417c-8a5a-fdf627208fceP0"><span xml:space="preserve" class="s4df2a81c-023a-417c-8a5a-fdf627208fceC0">    </span><span class="s4df2a81c-023a-417c-8a5a-fdf627208fceC0-000001">General Authority:</span><span xml:space="preserve" class="s4df2a81c-023a-417c-8a5a-fdf627208fceC0"> SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=28-6-1"><span class="s4df2a81c-023a-417c-8a5a-fdf627208fceC0-000003">28-6-1</span></a><span class="s4df2a81c-023a-417c-8a5a-fdf627208fceC0">.</span></p><p dir="ltr" class="s4df2a81c-023a-417c-8a5a-fdf627208fceP0"><span xml:space="preserve" class="s4df2a81c-023a-417c-8a5a-fdf627208fceC0">    </span><span class="s4df2a81c-023a-417c-8a5a-fdf627208fceC0-000001">Law Implemented:</span><span xml:space="preserve" class="s4df2a81c-023a-417c-8a5a-fdf627208fceC0"> SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=28-6-1"><span class="s4df2a81c-023a-417c-8a5a-fdf627208fceC0-000003">28-6-1</span></a><span class="s4df2a81c-023a-417c-8a5a-fdf627208fceC0">(1)(2)</span><span xml:space="preserve" class="s4df2a81c-023a-417c-8a5a-fdf627208fceC0">, </span><a href="https://sdlegislature.gov/Statutes?Statute=28-6-1"><span class="s4df2a81c-023a-417c-8a5a-fdf627208fceC0-000003">28-6-1</span></a><span class="s4df2a81c-023a-417c-8a5a-fdf627208fceC0">.1.</span></p><p dir="ltr" class="s4df2a81c-023a-417c-8a5a-fdf627208fceP0"><span xml:space="preserve" class="s4df2a81c-023a-417c-8a5a-fdf627208fce000002"> </span></p></div></body></html>