<html> <head> <title>Rule 67:54:06:13 Payment, procedure codes, and limits for covered services.</title> <META NAME="Keywords" Content="Administrative Rules 67:54:06:13"> <META NAME="Description" Content="Administrative Rules 67:54:06:13 Payment, procedure codes, and limits for covered services."> <meta name=Generator content="Microsoft Office HTML Filter 2.0"> <meta http-equiv=Content-Type content="text/html; charset=windows-1252"> <meta name=Originator content="Microsoft Word 10"> <style> <!-- --> </style> </head> <body lang=EN-US> <div> <p><font size=3 face="Times New Roman">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>67:54:06:13.&nbsp;&nbsp;Payment, procedure codes, and limits for covered services.</b> Payment for assistive daily living services is limited to the following procedure codes:</font></p> <p><font size=3 face="Times New Roman">&nbsp;</font></p> <table border=0 cellspacing=0 cellpadding=0> <tr> <td width=186 valign=top> <p><b><font size=3 face="Times New Roman">PROCEDURE</font></b></p> </td> <td width=297 valign=top> <p><b><font size=3 face="Times New Roman">&nbsp;</font></b></p> </td> <td width=153 valign=top> <p><b><font size=3 face="Times New Roman">&nbsp;</font></b></p> </td> </tr> <tr> <td width=186 valign=top> <p><b><font size=3 face="Times New Roman">CODE</font></b></p> </td> <td width=297 valign=top> <p><b><font size=3 face="Times New Roman">PROCEDURE</font></b></p> </td> <td width=153 valign=top> <p align=right><b><font size=3 face="Times New Roman">&nbsp;</font></b></p> </td> </tr> <tr> <td width=186 valign=top> <p><font size=3 face="Times New Roman">&nbsp;</font></p> </td> <td width=297 valign=top> <p><font size=3 face="Times New Roman">&nbsp;</font></p> </td> <td width=153 valign=top> <p align=right><font size=3 face="Times New Roman">&nbsp;</font></p> </td> </tr> <tr> <td width=186 valign=top> <p><font size=3 face="Times New Roman">T1019</font></p> </td> <td width=297 valign=top> <p><font size=3 face="Times New Roman">Services of a personal attendant</font></p> </td> <td width=153 valign=top> <p align=right><font size=3 face="Times New Roman">&nbsp;</font></p> </td> </tr> <tr> <td width=186 valign=top> <p><font size=3 face="Times New Roman">T1016</font></p> </td> <td width=297 valign=top> <p><font size=3 face="Times New Roman">Case management</font></p> </td> <td width=153 valign=top> <p align=right><font size=3 face="Times New Roman">&nbsp;</font></p> </td> </tr> <tr> <td width=186 valign=top> <p><font size=3 face="Times New Roman">S5115</font></p> </td> <td width=297 valign=top> <p><font size=3 face="Times New Roman">Consumer preparation</font></p> </td> <td width=153 valign=top> <p align=right><font size=3 face="Times New Roman">&nbsp;</font></p> </td> </tr> <tr> <td width=186 valign=top> <p><font size=3 face="Times New Roman">S5160</font></p> </td> <td width=297 valign=top> <p><font size=3 face="Times New Roman">Emergency response device</font></p> </td> <td width=153 valign=top> <p align=right><font size=3 face="Times New Roman">&nbsp;</font></p> </td> </tr> <tr> <td width=186 valign=top> <p><font size=3 face="Times New Roman">T1000</font></p> </td> <td width=297 valign=top> <p><font size=3 face="Times New Roman">Private duty nursing</font></p> </td> <td width=153 valign=top> <p align=right><font size=3 face="Times New Roman">&nbsp;</font></p> </td> </tr> </table> <p><font size=3 face="Times New Roman">&nbsp;</font></p> <p><font size=3 face="Times New Roman">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; A provider may bill for no more than three units of services of a personal attendant if the actual service time is less than 45 minutes and the personal attendant did not provide services for another consumer immediately preceding or subsequent to the services provided to the consumer on whose behalf the services are being billed.</font></p> <p><font size=3 face="Times New Roman">&nbsp;</font></p> <p><font size=3 face="Times New Roman">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; The Department of Human Services shall establish the rate of payment in the provider agency's contract.</font></p> <p><font size=3 face="Times New Roman">&nbsp;</font></p> <p><font size=3 face="Times New Roman">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>Source:</b> 21 SDR 230, effective July 13, 1995; 26 SDR 99, effective January 30, 2000; 30 SDR 135, effective March 16, 2004.</font></p> <p><font size=3 face="Times New Roman">&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(2).</A></font></p> <p><font size=3 face="Times New Roman">&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(2).</A></font></p> <p><font size=3 face="Times New Roman">&nbsp;</font></p> </div> </body> </html>