<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.s4b6294a1-2642-47f8-b92c-dd7b79ba7f6bP0 { 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.s4b6294a1-2642-47f8-b92c-dd7b79ba7f6bC0 { background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.s4b6294a1-2642-47f8-b92c-dd7b79ba7f6bC0-000000 { color: #0000FF; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.s4b6294a1-2642-47f8-b92c-dd7b79ba7f6bC0-000001 { background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.s4b6294a1-2642-47f8-b92c-dd7b79ba7f6bC0-000002 { color: #0000FF; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.s4b6294a1-2642-47f8-b92c-dd7b79ba7f6b000003 { background: white; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } </style></head><body><div><p dir="ltr" class="s4b6294a1-2642-47f8-b92c-dd7b79ba7f6bP0"><span xml:space="preserve" class="s4b6294a1-2642-47f8-b92c-dd7b79ba7f6bC0">    </span><a href="https://sdlegislature.gov/Rules?Rule=67:16:02:16.01"><span class="s4b6294a1-2642-47f8-b92c-dd7b79ba7f6bC0-000000">67:16:02:16.01</span></a><span class="s4b6294a1-2642-47f8-b92c-dd7b79ba7f6bC0-000001">.  Billing requirements -- Implantable contraceptive capsules and obstetrical services.</span><span xml:space="preserve" class="s4b6294a1-2642-47f8-b92c-dd7b79ba7f6bC0"> A claim submitted under this chapter for covered implantable contraceptive capsules and obstetrical services must be submitted at the provider's usual and customary charge and is limited to the nonlaboratory procedure codes listed in the applicable fee schedule</span><span xml:space="preserve" class="s4b6294a1-2642-47f8-b92c-dd7b79ba7f6bC0"> pursuant to § </span><a href="https://sdlegislature.gov/Rules?Rule=67:16:02:01.01"><span class="s4b6294a1-2642-47f8-b92c-dd7b79ba7f6bC0-000002">67:16:02:01.01</span></a><span class="s4b6294a1-2642-47f8-b92c-dd7b79ba7f6bC0">.</span></p><p dir="ltr" class="s4b6294a1-2642-47f8-b92c-dd7b79ba7f6bP0"><span xml:space="preserve" class="s4b6294a1-2642-47f8-b92c-dd7b79ba7f6b000003"> </span></p><p dir="ltr" class="s4b6294a1-2642-47f8-b92c-dd7b79ba7f6bP0"><span xml:space="preserve" class="s4b6294a1-2642-47f8-b92c-dd7b79ba7f6bC0">    A claim submitted for insertion or reinsertion, implantable contraceptive capsule may not include the cost of the kit. The kit must be billed separately.</span></p><p dir="ltr" class="s4b6294a1-2642-47f8-b92c-dd7b79ba7f6bP0"><span xml:space="preserve" class="s4b6294a1-2642-47f8-b92c-dd7b79ba7f6b000003"> </span></p><p dir="ltr" class="s4b6294a1-2642-47f8-b92c-dd7b79ba7f6bP0"><span xml:space="preserve" class="s4b6294a1-2642-47f8-b92c-dd7b79ba7f6bC0">    Providers must use the appropriate </span><span class="s4b6294a1-2642-47f8-b92c-dd7b79ba7f6bC0">current procedural terminology</span><span xml:space="preserve" class="s4b6294a1-2642-47f8-b92c-dd7b79ba7f6bC0"> code to indicate obstetric care, antepartum care, delivery, and postpartum care. When applicable, providers </span><span class="s4b6294a1-2642-47f8-b92c-dd7b79ba7f6bC0">shall</span><span xml:space="preserve" class="s4b6294a1-2642-47f8-b92c-dd7b79ba7f6bC0"> bill using the global delivery codes defined on the department's billing guidance website. A provider may not separate claims for antepartum care, delivery services, or postpartum care when using a global delivery code.</span></p><p dir="ltr" class="s4b6294a1-2642-47f8-b92c-dd7b79ba7f6bP0"><span xml:space="preserve" class="s4b6294a1-2642-47f8-b92c-dd7b79ba7f6b000003"> </span></p><p dir="ltr" class="s4b6294a1-2642-47f8-b92c-dd7b79ba7f6bP0"><span xml:space="preserve" class="s4b6294a1-2642-47f8-b92c-dd7b79ba7f6bC0">    A claim submitted for postpartum care is limited to hospital and office visits in the </span><span class="s4b6294a1-2642-47f8-b92c-dd7b79ba7f6bC0">sixty</span><span xml:space="preserve" class="s4b6294a1-2642-47f8-b92c-dd7b79ba7f6bC0"> days following vaginal or cesarean section delivery.</span></p><p dir="ltr" class="s4b6294a1-2642-47f8-b92c-dd7b79ba7f6bP0"><span xml:space="preserve" class="s4b6294a1-2642-47f8-b92c-dd7b79ba7f6b000003"> </span></p><p dir="ltr" class="s4b6294a1-2642-47f8-b92c-dd7b79ba7f6bP0"><span xml:space="preserve" class="s4b6294a1-2642-47f8-b92c-dd7b79ba7f6bC0">    </span><span class="s4b6294a1-2642-47f8-b92c-dd7b79ba7f6bC0-000001">Source:</span><span xml:space="preserve" class="s4b6294a1-2642-47f8-b92c-dd7b79ba7f6bC0"> 20 SDR 28, effective August 31, 1993; 20 SDR 149, effective March 21, 1994; 21 SDR 183, effective April 30, 1995; 23 SDR 38, effective September 26, 1996; 34 SDR 68, effective September 12, 2007; 42 SDR 51, effective October 13, 2015</span><span class="s4b6294a1-2642-47f8-b92c-dd7b79ba7f6bC0">; 43 SDR 80, effective December 5, 2016; 52 SDR 126, effective July 1, 2026</span><span class="s4b6294a1-2642-47f8-b92c-dd7b79ba7f6bC0">.</span></p><p dir="ltr" class="s4b6294a1-2642-47f8-b92c-dd7b79ba7f6bP0"><span xml:space="preserve" class="s4b6294a1-2642-47f8-b92c-dd7b79ba7f6bC0">    </span><span class="s4b6294a1-2642-47f8-b92c-dd7b79ba7f6bC0-000001">General Authority:</span><span xml:space="preserve" class="s4b6294a1-2642-47f8-b92c-dd7b79ba7f6bC0"> SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=28-6-1"><span class="s4b6294a1-2642-47f8-b92c-dd7b79ba7f6bC0-000002">28-6-1</span></a><span class="s4b6294a1-2642-47f8-b92c-dd7b79ba7f6bC0">.</span></p><p dir="ltr" class="s4b6294a1-2642-47f8-b92c-dd7b79ba7f6bP0"><span xml:space="preserve" class="s4b6294a1-2642-47f8-b92c-dd7b79ba7f6bC0">    </span><span class="s4b6294a1-2642-47f8-b92c-dd7b79ba7f6bC0-000001">Law Implemented:</span><span xml:space="preserve" class="s4b6294a1-2642-47f8-b92c-dd7b79ba7f6bC0"> SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=28-6-1"><span class="s4b6294a1-2642-47f8-b92c-dd7b79ba7f6bC0-000002">28-6-1</span></a><span xml:space="preserve" class="s4b6294a1-2642-47f8-b92c-dd7b79ba7f6bC0">, </span><a href="https://sdlegislature.gov/Statutes?Statute=28-6-1.1"><span class="s4b6294a1-2642-47f8-b92c-dd7b79ba7f6bC0-000002">28-6-1.1</span></a><span class="s4b6294a1-2642-47f8-b92c-dd7b79ba7f6bC0">.</span></p><p dir="ltr" class="s4b6294a1-2642-47f8-b92c-dd7b79ba7f6bP0"><span xml:space="preserve" class="s4b6294a1-2642-47f8-b92c-dd7b79ba7f6b000003"> </span></p><p dir="ltr" class="s4b6294a1-2642-47f8-b92c-dd7b79ba7f6bP0"><span xml:space="preserve" class="s4b6294a1-2642-47f8-b92c-dd7b79ba7f6bC0">    </span><span class="s4b6294a1-2642-47f8-b92c-dd7b79ba7f6bC0-000001">Cross-Reference:</span></p><p dir="ltr" class="s4b6294a1-2642-47f8-b92c-dd7b79ba7f6bP0"><span xml:space="preserve" class="s4b6294a1-2642-47f8-b92c-dd7b79ba7f6bC0-000001">    </span><span xml:space="preserve" class="s4b6294a1-2642-47f8-b92c-dd7b79ba7f6bC0">Definitions, "Webiste" (Fee Schedule Website), subdivision </span><a href="https://sdlegislature.gov/Rules?Rule=67:16:01:01"><span class="s4b6294a1-2642-47f8-b92c-dd7b79ba7f6bC0-000002">67:16:01:01</span></a><span class="s4b6294a1-2642-47f8-b92c-dd7b79ba7f6bC0">(18).</span></p><p dir="ltr" class="s4b6294a1-2642-47f8-b92c-dd7b79ba7f6bP0"><span xml:space="preserve" class="s4b6294a1-2642-47f8-b92c-dd7b79ba7f6b000003"> </span></p></div></body></html>