<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.s77525662-d379-4000-8abe-7511f9611f69P0 { 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.s77525662-d379-4000-8abe-7511f9611f69C0 { color: #000000; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.s77525662-d379-4000-8abe-7511f9611f69C0-000000 { color: #0000FF; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.s77525662-d379-4000-8abe-7511f9611f69C0-000001 { color: #000000; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.s77525662-d379-4000-8abe-7511f9611f69000002 { color: #000000; background: white; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.s77525662-d379-4000-8abe-7511f9611f69C0-000003 { 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="s77525662-d379-4000-8abe-7511f9611f69P0"><span xml:space="preserve" class="s77525662-d379-4000-8abe-7511f9611f69C0">    </span><a href="https://sdlegislature.gov/Rules?Rule=67:16:29:09"><span class="s77525662-d379-4000-8abe-7511f9611f69C0-000000">67:16:29:09</span></a><span class="s77525662-d379-4000-8abe-7511f9611f69C0-000001">.  Billing requirements.</span><span xml:space="preserve" class="s77525662-d379-4000-8abe-7511f9611f69C0"> Claims for medical equipment must be submitted at the provider's usual and customary charge. If it is the provider's custom to charge the general public for handling, delivery, and taxes, those charges may be included in the provider's usual and customary charge. A provider may not bill</span><span xml:space="preserve" class="s77525662-d379-4000-8abe-7511f9611f69C0"> the department</span><span xml:space="preserve" class="s77525662-d379-4000-8abe-7511f9611f69C0"> for equipment until the equipment has been delivered to the recipient. </span></p><p dir="ltr" class="s77525662-d379-4000-8abe-7511f9611f69P0"><span xml:space="preserve" class="s77525662-d379-4000-8abe-7511f9611f69000002"> </span></p><p dir="ltr" class="s77525662-d379-4000-8abe-7511f9611f69P0"><span xml:space="preserve" class="s77525662-d379-4000-8abe-7511f9611f69C0">    A copy of the physician</span><span class="s77525662-d379-4000-8abe-7511f9611f69C0">'s or other licensed practitioner's</span><span xml:space="preserve" class="s77525662-d379-4000-8abe-7511f9611f69C0"> written prescription, the invoice showing the purchase price of the equipment, and other documentation does not need to be submitted with the claim unless required</span><span class="s77525662-d379-4000-8abe-7511f9611f69C0">.</span><span xml:space="preserve" class="s77525662-d379-4000-8abe-7511f9611f69C0"> </span><span xml:space="preserve" class="s77525662-d379-4000-8abe-7511f9611f69C0">If these are submitted, </span><span class="s77525662-d379-4000-8abe-7511f9611f69C0">the provider</span><span xml:space="preserve" class="s77525662-d379-4000-8abe-7511f9611f69C0"> must maintain the documents</span><span xml:space="preserve" class="s77525662-d379-4000-8abe-7511f9611f69C0"> in the recipient's </span><span xml:space="preserve" class="s77525662-d379-4000-8abe-7511f9611f69C0">medical </span><span class="s77525662-d379-4000-8abe-7511f9611f69C0">record and ma</span><span class="s77525662-d379-4000-8abe-7511f9611f69C0">k</span><span class="s77525662-d379-4000-8abe-7511f9611f69C0">e</span><span xml:space="preserve" class="s77525662-d379-4000-8abe-7511f9611f69C0"> the documents</span><span xml:space="preserve" class="s77525662-d379-4000-8abe-7511f9611f69C0"> available </span><span class="s77525662-d379-4000-8abe-7511f9611f69C0">up</span><span class="s77525662-d379-4000-8abe-7511f9611f69C0">on request.</span></p><p dir="ltr" class="s77525662-d379-4000-8abe-7511f9611f69P0"><span xml:space="preserve" class="s77525662-d379-4000-8abe-7511f9611f69000002"> </span></p><p dir="ltr" class="s77525662-d379-4000-8abe-7511f9611f69P0"><span xml:space="preserve" class="s77525662-d379-4000-8abe-7511f9611f69C0">    Covered equipment </span><span class="s77525662-d379-4000-8abe-7511f9611f69C0">is</span><span xml:space="preserve" class="s77525662-d379-4000-8abe-7511f9611f69C0"> billed using the applicable procedure code contained in </span><span class="s77525662-d379-4000-8abe-7511f9611f69C0-000001">Health Care Common Procedure Coding System.</span></p><p dir="ltr" class="s77525662-d379-4000-8abe-7511f9611f69P0"><span xml:space="preserve" class="s77525662-d379-4000-8abe-7511f9611f69000002"> </span></p><p dir="ltr" class="s77525662-d379-4000-8abe-7511f9611f69P0"><span xml:space="preserve" class="s77525662-d379-4000-8abe-7511f9611f69C0">    A provider may not submit claims that do not meet the criteria contained in this chapter.</span></p><p dir="ltr" class="s77525662-d379-4000-8abe-7511f9611f69P0"><span xml:space="preserve" class="s77525662-d379-4000-8abe-7511f9611f69000002"> </span></p><p dir="ltr" class="s77525662-d379-4000-8abe-7511f9611f69P0"><span xml:space="preserve" class="s77525662-d379-4000-8abe-7511f9611f69C0">    A provider may not submit a claim for hearing aids until after </span><span class="s77525662-d379-4000-8abe-7511f9611f69C0">thirty</span><span xml:space="preserve" class="s77525662-d379-4000-8abe-7511f9611f69C0"> days of placement. A provider may not submit a claim if the hearing aids are returned during a trial period.</span></p><p dir="ltr" class="s77525662-d379-4000-8abe-7511f9611f69P0"><span xml:space="preserve" class="s77525662-d379-4000-8abe-7511f9611f69000002"> </span></p><p dir="ltr" class="s77525662-d379-4000-8abe-7511f9611f69P0"><span xml:space="preserve" class="s77525662-d379-4000-8abe-7511f9611f69C0">    </span><span class="s77525662-d379-4000-8abe-7511f9611f69C0-000001">Source:</span><span xml:space="preserve" class="s77525662-d379-4000-8abe-7511f9611f69C0"> 16 SDR 239, effective July 9, 1990; 17 SDR 194, effective July 1, 1991; 18 SDR 210, effective June 23, 1992; 19 SDR 26, effective August 23, 1992; 24 SDR 11, effective August 4, 1997; 29 SDR 116, effective February 23, 2003; 34 SDR 68, effective September 12, 2007; 35 SDR 49, effective September 10, 2008; 42 SDR 51, effective October 13, 2015</span><span class="s77525662-d379-4000-8abe-7511f9611f69C0">; 44 SDR 94, effective December 4, 2017</span><span class="s77525662-d379-4000-8abe-7511f9611f69C0">; 47 SDR 38, effective October 6, 2020</span><span class="s77525662-d379-4000-8abe-7511f9611f69C0">; 50 SDR 63, effective November 27, 2023</span><span class="s77525662-d379-4000-8abe-7511f9611f69C0">.</span></p><p dir="ltr" class="s77525662-d379-4000-8abe-7511f9611f69P0"><span xml:space="preserve" class="s77525662-d379-4000-8abe-7511f9611f69C0">    </span><span class="s77525662-d379-4000-8abe-7511f9611f69C0-000001">General Authority:</span><span xml:space="preserve" class="s77525662-d379-4000-8abe-7511f9611f69C0"> SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=28-6-1"><span class="s77525662-d379-4000-8abe-7511f9611f69C0-000003">28-6-1</span></a><span class="s77525662-d379-4000-8abe-7511f9611f69C0">.</span></p><p dir="ltr" class="s77525662-d379-4000-8abe-7511f9611f69P0"><span xml:space="preserve" class="s77525662-d379-4000-8abe-7511f9611f69C0">    </span><span class="s77525662-d379-4000-8abe-7511f9611f69C0-000001">Law Implemented:</span><span xml:space="preserve" class="s77525662-d379-4000-8abe-7511f9611f69C0"> SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=28-6-1"><span class="s77525662-d379-4000-8abe-7511f9611f69C0-000003">28-6-1</span></a><span xml:space="preserve" class="s77525662-d379-4000-8abe-7511f9611f69C0">, </span><a href="https://sdlegislature.gov/Statutes?Statute=28-6-1"><span class="s77525662-d379-4000-8abe-7511f9611f69C0-000003">28-6-1</span></a><span class="s77525662-d379-4000-8abe-7511f9611f69C0">.1.</span></p><p dir="ltr" class="s77525662-d379-4000-8abe-7511f9611f69P0"><span xml:space="preserve" class="s77525662-d379-4000-8abe-7511f9611f69000002"> </span></p><p dir="ltr" class="s77525662-d379-4000-8abe-7511f9611f69P0"><span xml:space="preserve" class="s77525662-d379-4000-8abe-7511f9611f69C0">    </span><span class="s77525662-d379-4000-8abe-7511f9611f69C0-000001">Cross-References:</span></p><p dir="ltr" class="s77525662-d379-4000-8abe-7511f9611f69P0"><span xml:space="preserve" class="s77525662-d379-4000-8abe-7511f9611f69C0">    </span><span xml:space="preserve" class="s77525662-d379-4000-8abe-7511f9611f69C0">Claim requirements, § </span><a href="https://sdlegislature.gov/Rules?Rule=67:16:29:11"><span class="s77525662-d379-4000-8abe-7511f9611f69C0-000003">67:16:29:11</span></a><span class="s77525662-d379-4000-8abe-7511f9611f69C0">.</span></p><p dir="ltr" class="s77525662-d379-4000-8abe-7511f9611f69P0"><span xml:space="preserve" class="s77525662-d379-4000-8abe-7511f9611f69C0">    Use of H</span><span xml:space="preserve" class="s77525662-d379-4000-8abe-7511f9611f69C0">ealth </span><span class="s77525662-d379-4000-8abe-7511f9611f69C0">C</span><span xml:space="preserve" class="s77525662-d379-4000-8abe-7511f9611f69C0">are </span><span class="s77525662-d379-4000-8abe-7511f9611f69C0">C</span><span xml:space="preserve" class="s77525662-d379-4000-8abe-7511f9611f69C0">ommon Procedure Coding </span><span class="s77525662-d379-4000-8abe-7511f9611f69C0">S</span><span class="s77525662-d379-4000-8abe-7511f9611f69C0">ystem</span><span xml:space="preserve" class="s77525662-d379-4000-8abe-7511f9611f69C0">, § </span><a href="https://sdlegislature.gov/Rules?Rule=67:16:01:27"><span class="s77525662-d379-4000-8abe-7511f9611f69C0-000003">67:16:01:27</span></a><span class="s77525662-d379-4000-8abe-7511f9611f69C0">.</span></p><p dir="ltr" class="s77525662-d379-4000-8abe-7511f9611f69P0"><span xml:space="preserve" class="s77525662-d379-4000-8abe-7511f9611f69000002"> </span></p></div></body></html>