<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.se67cc49d-37e5-4a80-bc52-0a88714902c7P0 { 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.se67cc49d-37e5-4a80-bc52-0a88714902c7C0 { background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.se67cc49d-37e5-4a80-bc52-0a88714902c7C0-000000 { color: #0000FF; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.se67cc49d-37e5-4a80-bc52-0a88714902c7C0-000001 { background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.se67cc49d-37e5-4a80-bc52-0a88714902c7000002 { background: white; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.se67cc49d-37e5-4a80-bc52-0a88714902c7C0-000003 { color: #0000FF; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } p.se67cc49d-37e5-4a80-bc52-0a88714902c7P0-000004 { margin-top: 0; line-height: 115.0%; margin-bottom: 10pt; margin-left: 0; margin-right: 0; text-indent: 0.00in; text-align: left; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; } </style></head><body><div><p dir="ltr" class="se67cc49d-37e5-4a80-bc52-0a88714902c7P0"><span xml:space="preserve" class="se67cc49d-37e5-4a80-bc52-0a88714902c7C0">    </span><a href="https://sdlegislature.gov/Rules?Rule=67:16:03:06.18"><span class="se67cc49d-37e5-4a80-bc52-0a88714902c7C0-000000">67</span><span class="se67cc49d-37e5-4a80-bc52-0a88714902c7C0-000000">:</span><span class="se67cc49d-37e5-4a80-bc52-0a88714902c7C0-000000">16</span><span class="se67cc49d-37e5-4a80-bc52-0a88714902c7C0-000000">:</span><span class="se67cc49d-37e5-4a80-bc52-0a88714902c7C0-000000">03</span><span class="se67cc49d-37e5-4a80-bc52-0a88714902c7C0-000000">:</span><span class="se67cc49d-37e5-4a80-bc52-0a88714902c7C0-000000">06.18</span></a><span class="se67cc49d-37e5-4a80-bc52-0a88714902c7C0-000001">.  B</span><span class="se67cc49d-37e5-4a80-bc52-0a88714902c7C0-000001">a</span><span xml:space="preserve" class="se67cc49d-37e5-4a80-bc52-0a88714902c7C0-000001">sis of </span><span class="se67cc49d-37e5-4a80-bc52-0a88714902c7C0-000001">r</span><span xml:space="preserve" class="se67cc49d-37e5-4a80-bc52-0a88714902c7C0-000001">eimbursement -- </span><span class="se67cc49d-37e5-4a80-bc52-0a88714902c7C0-000001">Outpatient prospective payment system</span><span class="se67cc49d-37e5-4a80-bc52-0a88714902c7C0-000001">.</span><span xml:space="preserve" class="se67cc49d-37e5-4a80-bc52-0a88714902c7C0"> Medicare prospective payment</span><span xml:space="preserve" class="se67cc49d-37e5-4a80-bc52-0a88714902c7C0"> </span><span xml:space="preserve" class="se67cc49d-37e5-4a80-bc52-0a88714902c7C0">system hospitals </span><span class="se67cc49d-37e5-4a80-bc52-0a88714902c7C0">and out-of-state hospitals must</span><span xml:space="preserve" class="se67cc49d-37e5-4a80-bc52-0a88714902c7C0"> be paid using the </span><span class="se67cc49d-37e5-4a80-bc52-0a88714902c7C0">department's outpatient prospective payment system (OPPS)</span><span xml:space="preserve" class="se67cc49d-37e5-4a80-bc52-0a88714902c7C0">. Under </span><span xml:space="preserve" class="se67cc49d-37e5-4a80-bc52-0a88714902c7C0">the </span><span class="se67cc49d-37e5-4a80-bc52-0a88714902c7C0">OPPS, services are</span><span xml:space="preserve" class="se67cc49d-37e5-4a80-bc52-0a88714902c7C0"> </span><span class="se67cc49d-37e5-4a80-bc52-0a88714902c7C0">reimbursed using ambulatory payment classifications. The conversion</span><span xml:space="preserve" class="se67cc49d-37e5-4a80-bc52-0a88714902c7C0"> </span><span class="se67cc49d-37e5-4a80-bc52-0a88714902c7C0">factor</span><span class="se67cc49d-37e5-4a80-bc52-0a88714902c7C0">, weights,</span><span xml:space="preserve" class="se67cc49d-37e5-4a80-bc52-0a88714902c7C0"> and </span><span class="se67cc49d-37e5-4a80-bc52-0a88714902c7C0">fee schedule rates for services not assigned an ambulatory payment classification</span><span xml:space="preserve" class="se67cc49d-37e5-4a80-bc52-0a88714902c7C0"> are published on the </span><span class="se67cc49d-37e5-4a80-bc52-0a88714902c7C0">d</span><span class="se67cc49d-37e5-4a80-bc52-0a88714902c7C0">epartment's fee schedule</span><span xml:space="preserve" class="se67cc49d-37e5-4a80-bc52-0a88714902c7C0"> website</span><span class="se67cc49d-37e5-4a80-bc52-0a88714902c7C0">.</span></p><p dir="ltr" class="se67cc49d-37e5-4a80-bc52-0a88714902c7P0"><span xml:space="preserve" class="se67cc49d-37e5-4a80-bc52-0a88714902c7000002"> </span></p><p dir="ltr" class="se67cc49d-37e5-4a80-bc52-0a88714902c7P0"><span xml:space="preserve" class="se67cc49d-37e5-4a80-bc52-0a88714902c7C0">    </span><span class="se67cc49d-37e5-4a80-bc52-0a88714902c7C0">Outpatient prospective payments may not include any item or service for which payment may be made under other provisions of this article, unless the item or service is specifically included on the department's fee schedule website.</span></p><p dir="ltr" class="se67cc49d-37e5-4a80-bc52-0a88714902c7P0"><span xml:space="preserve" class="se67cc49d-37e5-4a80-bc52-0a88714902c7000002"> </span></p><p dir="ltr" class="se67cc49d-37e5-4a80-bc52-0a88714902c7P0"><span xml:space="preserve" class="se67cc49d-37e5-4a80-bc52-0a88714902c7C0">    </span><span class="se67cc49d-37e5-4a80-bc52-0a88714902c7C0-000001">Source:</span><span xml:space="preserve" class="se67cc49d-37e5-4a80-bc52-0a88714902c7C0"> </span><span class="se67cc49d-37e5-4a80-bc52-0a88714902c7C0">43</span><span xml:space="preserve" class="se67cc49d-37e5-4a80-bc52-0a88714902c7C0"> SDR </span><span class="se67cc49d-37e5-4a80-bc52-0a88714902c7C0">80</span><span xml:space="preserve" class="se67cc49d-37e5-4a80-bc52-0a88714902c7C0">, effective </span><span class="se67cc49d-37e5-4a80-bc52-0a88714902c7C0">December 5, 2016; 52 SDR 126, effective July 1, 2026</span><span class="se67cc49d-37e5-4a80-bc52-0a88714902c7C0">.</span></p><p dir="ltr" class="se67cc49d-37e5-4a80-bc52-0a88714902c7P0"><span xml:space="preserve" class="se67cc49d-37e5-4a80-bc52-0a88714902c7C0">    </span><span class="se67cc49d-37e5-4a80-bc52-0a88714902c7C0-000001">General Authority:</span><span xml:space="preserve" class="se67cc49d-37e5-4a80-bc52-0a88714902c7C0"> SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=28-6-1"><span class="se67cc49d-37e5-4a80-bc52-0a88714902c7C0-000003">28-6-1</span></a><span class="se67cc49d-37e5-4a80-bc52-0a88714902c7C0">.</span></p><p dir="ltr" class="se67cc49d-37e5-4a80-bc52-0a88714902c7P0"><span xml:space="preserve" class="se67cc49d-37e5-4a80-bc52-0a88714902c7C0">    </span><span class="se67cc49d-37e5-4a80-bc52-0a88714902c7C0-000001">Law Implemented:</span><span xml:space="preserve" class="se67cc49d-37e5-4a80-bc52-0a88714902c7C0"> SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=28-6-1"><span class="se67cc49d-37e5-4a80-bc52-0a88714902c7C0-000003">28-6-1</span></a><span xml:space="preserve" class="se67cc49d-37e5-4a80-bc52-0a88714902c7C0">, </span><a href="https://sdlegislature.gov/Statutes?Statute=28-6-1.1"><span class="se67cc49d-37e5-4a80-bc52-0a88714902c7C0-000003">28-6-1.1</span></a><span class="se67cc49d-37e5-4a80-bc52-0a88714902c7C0">.</span></p><p dir="ltr" class="se67cc49d-37e5-4a80-bc52-0a88714902c7P0"><span xml:space="preserve" class="se67cc49d-37e5-4a80-bc52-0a88714902c7000002"> </span></p><p dir="ltr" class="se67cc49d-37e5-4a80-bc52-0a88714902c7P0"><span xml:space="preserve" class="se67cc49d-37e5-4a80-bc52-0a88714902c7C0">    </span><span class="se67cc49d-37e5-4a80-bc52-0a88714902c7C0-000001">Cross-Reference:</span></p><p dir="ltr" class="se67cc49d-37e5-4a80-bc52-0a88714902c7P0"><span xml:space="preserve" class="se67cc49d-37e5-4a80-bc52-0a88714902c7C0-000001">    </span><span xml:space="preserve" class="se67cc49d-37e5-4a80-bc52-0a88714902c7C0">Definitions, "Website" (Fee Schedule Website), subdivision </span><a href="https://sdlegislature.gov/Rules?Rule=67:16:01:01"><span class="se67cc49d-37e5-4a80-bc52-0a88714902c7C0-000003">67:16:01:01</span></a><span class="se67cc49d-37e5-4a80-bc52-0a88714902c7C0">(18).</span></p><p dir="ltr" class="se67cc49d-37e5-4a80-bc52-0a88714902c7P0-000004"><span xml:space="preserve" class="se67cc49d-37e5-4a80-bc52-0a88714902c7000002"> </span></p></div></body></html>