<html> <head> <title>Rule 20:06:27:01 Definitions.</title> <META NAME="Keywords" Content="Administrative Rules 20:06:27:01"> <META NAME="Description" Content="Administrative Rules 20:06:27:01 Definitions."> <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>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>20:06:27:01.&nbsp;&nbsp;Definitions.</b> Terms used in this section mean:</p> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (1)&nbsp;&nbsp;&quot;ASC Z12N standard format,&quot; the standards for electronic data interchange within the health care industry developed by the Accredited Standards Committee Z12N Insurance Subcommittee of the American National Standards Institute;</p> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (2)&nbsp;&nbsp;&quot;CDT-2 codes,&quot; the current dental terminology prescribed by the American Dental Association;</p> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (3)&nbsp;&nbsp;&quot;CPT-4 codes,&quot; codes for medical services and procedures performed by medical providers as listed in Physicians Current Procedural Terminology, (CPT '95) Fourth Edition, published by the American Medical Association;</p> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (4)&nbsp;&nbsp;&quot;HCFA,&quot; the Health Care Financing Administration of the U.S. Department of Health and Human Services;</p> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (5)&nbsp;&nbsp;&quot;HCFA Form 1450,&quot; the health insurance claim form maintained by HCFA for use by institutional care practitioners;</p> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (6)&nbsp;&nbsp;&quot;HCFA Form 1500,&quot; the health insurance claim form maintained by HCFA for use by health care practitioners;</p> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (7)&nbsp;&nbsp;&quot;HCPCS,&quot; HCFA's common procedure coding system which describes products, supplies, procedures, and health professional services;</p> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (8)&nbsp;&nbsp;&quot;HCPCS Level 1 Codes,&quot; the AMA's CPT-4 codes and modifiers for professional services and procedures;</p> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (9)&nbsp;&nbsp;&quot;HCPCS Level 2 Codes,&quot; alphanumeric codes and modifiers for health care products and supplies, as well as some codes for professional services not included in the AMA's CPT-4;</p> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (10)&nbsp;&nbsp;&quot;HCPCS Level 3 Codes,&quot; local alphanumeric codes and modifiers for items and services not included in the HCPCS Level 1 or HCPCS Level 2;</p> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (11)&nbsp;&nbsp;&quot;Health care practitioner,&quot; a provider of health care as follows:</p> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (a)&nbsp;&nbsp; A chiropractor licensed under SDCL chapter <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=36-5">36-5</A>;</p> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (b)&nbsp;&nbsp; A corporation or partnership of health care practitioners listed in this subdivision;</p> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (c)&nbsp;&nbsp; A dentist licensed under SDCL chapter <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=36-6A">36-6A</A>;</p> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (d)&nbsp;&nbsp; A nurse licensed under SDCL chapter <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=36-9">36-9</A> or 36-9A;</p> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (e)&nbsp;&nbsp; An optometrist licensed under SDCL chapter <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=36-7">36-7</A>;</p> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (f)&nbsp;&nbsp;&nbsp; A physician licensed under SDCL chapter <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=36-4">36-4</A>;</p> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (g)&nbsp;&nbsp; A podiatrist licensed under SDCL chapter <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=36-8">36-8</A>;</p> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (h)&nbsp;&nbsp; A psychologist licensed under SDCL chapter <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=36-27A">36-27A</A>;</p> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (i)&nbsp;&nbsp;&nbsp; A speech, physical, respiratory, or occupational therapist licensed under SDCL chapter <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=36-10">36-10</A> or 36-31;</p> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (j)&nbsp;&nbsp;&nbsp; A medical assistant licensed under SDCL chapter <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=36-9B">36-9B</A>;</p> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (k)&nbsp;&nbsp; A physician assistant licensed under SDCL chapter <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=36-4A">36-4A</A>; or</p> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (l)&nbsp;&nbsp;&nbsp; An emergency medical technician licensed under SDCL chapter <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=36-4B">36-4B</A>;</p> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (12)&nbsp;&nbsp;&quot;ICD-9-CM codes,&quot; the diagnosis and procedure codes in the International Classification of Diseases, Ninth Revision, Clinical Modification published by the U.S. Department of Health and Human Services;</p> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (13)&nbsp;&nbsp;&quot;Institutional care practitioner,&quot; a facility licensed under SDCL chapter <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=34-12">34-12</A> or listed in §&nbsp;44:04:01:02;</p> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (14)&nbsp;&nbsp;&quot;Issuer,&quot; an insurance company, fraternal benefit society, health care service plan, health maintenance organization, third party administrator, and any other entity reimbursing the costs of health care expenses;</p> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (15)&nbsp;&nbsp;&quot;J512 form,&quot; the uniform dental claim form approved by the American Dental Association for use by dentists;</p> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (16)&nbsp;&nbsp;&quot;Revenue codes,&quot; the codes established for use by institutional care practitioners by the National Uniform Billing Committee.</p> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>Source:</b> 22 SDR 97, effective December 18, 1995.</p> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>General Authority:</b> SDCL <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=58-12-14">58-12-14.</A></p> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>Law Implemented:</b> SDCL <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=58-12-12">58-12-12.</A></p> </div> </body> </html>