<html> <head> <meta name=Generator content="Microsoft Office HTML Filter 2.0"> <meta http-equiv=Content-Type content="text/html; charset=windows-1252"> <style> <!-- --> </style> </head> <body lang=EN-US link=blue vlink="#954F72"> <div> <p align=center><b>CHAPTER 67:16:02</b></p> <p align=center><b>PHYSICIAN AND OTHER HEALTH SERVICES</b></p> <p>Section</p> <p><a href="DisplayRule.aspx?Rule=67:16:02:01">67:16:02:01</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Definitions.</p> <p><a href="DisplayRule.aspx?Rule=67:16:02:01.01">67:16:02:01.01</a>&nbsp;&nbsp; Fee schedules for physician services.</p> <p><a href="DisplayRule.aspx?Rule=67:16:02:02">67:16:02:02</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Repealed.</p> <p><a href="DisplayRule.aspx?Rule=67:16:02:03">67:16:02:03</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Rate of payment.</p> <p><a href="DisplayRule.aspx?Rule=67:16:02:03.01">67:16:02:03.01</a>&nbsp;&nbsp; Reimbursement for multiple surgeries.</p> <p><a href="DisplayRule.aspx?Rule=67:16:02:03.02">67:16:02:03.02</a>&nbsp;&nbsp; Reimbursement for services containing modifier codes.</p> <p><a href="DisplayRule.aspx?Rule=67:16:02:03.03">67:16:02:03.03</a>&nbsp;&nbsp; Required modifier codes.</p> <p><a href="DisplayRule.aspx?Rule=67:16:02:04">67:16:02:04</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Physician's services covered.</p> <p><a href="DisplayRule.aspx?Rule=67:16:02:05">67:16:02:05</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Other health services covered.</p> <p><a href="DisplayRule.aspx?Rule=67:16:02:05.01">67:16:02:05.01</a>&nbsp;&nbsp; Physical therapy services covered.</p> <p><a href="DisplayRule.aspx?Rule=67:16:02:05.02">67:16:02:05.02</a>&nbsp;&nbsp; Repealed.</p> <p><a href="DisplayRule.aspx?Rule=67:16:02:05.03">67:16:02:05.03</a>&nbsp;&nbsp; Repealed.</p> <p><a href="DisplayRule.aspx?Rule=67:16:02:05.04">67:16:02:05.04</a>&nbsp;&nbsp; Repealed.</p> <p><a href="DisplayRule.aspx?Rule=67:16:02:05.05">67:16:02:05.05</a>&nbsp;&nbsp; Repealed.</p> <p><a href="DisplayRule.aspx?Rule=67:16:02:05.06">67:16:02:05.06</a>&nbsp;&nbsp; Repealed.</p> <p><a href="DisplayRule.aspx?Rule=67:16:02:05.07">67:16:02:05.07</a>&nbsp;&nbsp; Repealed.</p> <p><a href="DisplayRule.aspx?Rule=67:16:02:05.08">67:16:02:05.08</a>&nbsp;&nbsp; Repealed.</p> <p><a href="DisplayRule.aspx?Rule=67:16:02:05.09">67:16:02:05.09</a>&nbsp;&nbsp; Repealed.</p> <p><a href="DisplayRule.aspx?Rule=67:16:02:05.10">67:16:02:05.10</a>&nbsp;&nbsp; Repealed.</p> <p><a href="DisplayRule.aspx?Rule=67:16:02:05.11">67:16:02:05.11</a>&nbsp;&nbsp; Repealed.</p> <p><a href="DisplayRule.aspx?Rule=67:16:02:05.12">67:16:02:05.12</a>&nbsp;&nbsp; Repealed.</p> <p><a href="DisplayRule.aspx?Rule=67:16:02:05.13">67:16:02:05.13</a>&nbsp;&nbsp; Repealed.</p> <p><a href="DisplayRule.aspx?Rule=67:16:02:05.14">67:16:02:05.14</a>&nbsp;&nbsp; Repealed.</p> <p><a href="DisplayRule.aspx?Rule=67:16:02:05.15">67:16:02:05.15</a>&nbsp;&nbsp; Occupational therapy.</p> <p><a href="DisplayRule.aspx?Rule=67:16:02:06">67:16:02:06</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Health services not covered.</p> <p><a href="DisplayRule.aspx?Rule=67:16:02:07">67:16:02:07</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Utilization review for physician, laboratory, and X-ray services.</p> <p><a href="DisplayRule.aspx?Rule=67:16:02:08">67:16:02:08</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Repealed.</p> <p><a href="DisplayRule.aspx?Rule=67:16:02:09">67:16:02:09</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Sterilization.</p> <p><a href="DisplayRule.aspx?Rule=67:16:02:10">67:16:02:10</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Refractions and eyeglasses.</p> <p><a href="DisplayRule.aspx?Rule=67:16:02:11">67:16:02:11</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Repealed.</p> <p><a href="DisplayRule.aspx?Rule=67:16:02:12">67:16:02:12</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Transferred.</p> <p><a href="DisplayRule.aspx?Rule=67:16:02:13">67:16:02:13</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Audiological and speech pathology services.</p> <p><a href="DisplayRule.aspx?Rule=67:16:02:14">67:16:02:14</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Reimbursement for services provided by nurse midwife or nurse anesthetist.</p> <p><a href="DisplayRule.aspx?Rule=67:16:02:15">67:16:02:15</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Reimbursement for services provided by nurse practitioner, clinical nurse specialist, or physician assistant.</p> <p><a href="DisplayRule.aspx?Rule=67:16:02:16">67:16:02:16</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Billing requirements -- Modifier codes -- Provider identification numbers.</p> <p><a href="DisplayRule.aspx?Rule=67:16:02:16.01">67:16:02:16.01</a>&nbsp;&nbsp; Billing requirements -- Implantable contraceptive capsules and obstetrical services.</p> <p><a href="DisplayRule.aspx?Rule=67:16:02:17">67:16:02:17</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Claim requirements.</p> <p><a href="DisplayRule.aspx?Rule=67:16:02:18">67:16:02:18</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Repealed.</p> <p><a href="DisplayRule.aspx?Rule=67:16:02:19">67:16:02:19</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Application of other chapters.</p> <p><a href="DisplayRule.aspx?Rule=67:16:02:0A">Appendix A</a>&nbsp; List of Physician Nonlaboratory Procedures, repealed, 34 SDR 68, effective September 12, 2007.</p> <p><a href="DisplayRule.aspx?Rule=67:16:02:0B">Appendix B</a>&nbsp; List of Physician Laboratory Procedures, repealed, 34 SDR 68, effective September 12, 2007.</p> <p><a href="DisplayRule.aspx?Rule=67:16:02:0C">Appendix C</a>&nbsp; Physician Medical Procedures -- Medicare Maximum Allowance; repealed, 34 SDR 68, effective September 12, 2007.</p> <p><a href="DisplayRule.aspx?Rule=67:16:02:0D">Appendix D</a>&nbsp; List of Modifier Codes for Physician Services, transferred to §&nbsp;67:16:02:03.03, effective September 12, 2007.</p> <p><a href="DisplayRule.aspx?Rule=67:16:02:0E">Appendix E</a>&nbsp; Clozaril Enrollment Information Form, repealed, 31 SDR 214, effective July 6, 2005.</p> </div> </body> </html> <br /><hr><br /><html xmlns:v="urn:schemas-microsoft-com:vml" xmlns:o="urn:schemas-microsoft-com:office:office" xmlns:w="urn:schemas-microsoft-com:office:word" xmlns="http://www.w3.org/TR/REC-html40"> <head> <title>Rule 67:16:02:0A List of Physician Nonlaboratory Procedures.</title> <META NAME="Keywords" Content="Administrative Rules 67:16:02:0A"> <META NAME="Description" Content="Administrative Rules 67:16:02:0A List of Physician Nonlaboratory Procedures."> <meta http-equiv=Content-Type content="text/html; charset=windows-1252"> <meta name=ProgId content=Word.Document> <meta name=Generator content="Microsoft Word 10"> <meta name=Originator content="Microsoft Word 10"> <link rel=File-List 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3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal style='tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal style='tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal style='tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal style='tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal style='tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal style='tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal style='tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal style='tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal style='tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'>DEPARTMENT OF SOCIAL SERVICES<o:p></o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'>OFFICE OF MEDICAL SERVICES<o:p></o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'>LIST OF PHYSICIAN NONLABORATORY PROCEDURES<o:p></o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'>Chapter 67:16:02<o:p></o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'>APPENDIX A<o:p></o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'>SEE: &#167; 67:16:02:03<o:p></o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'>(Repealed)<o:p></o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal style='text-align:justify;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><span style='mso-tab-count:1'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span><b style='mso-bidi-font-weight:normal'><span style='font-weight:bold;mso-bidi-font-weight: normal'>Source:</span></b> 16 SDR 64, effective October 8, 1989; 17 SDR 200, effective July 1, 1991; 18 SDR 163, effective April 6, 1992; 19 SDR 82, effective December 7, 1992; 20 SDR 28, effective August 31, 1993; 21 SDR 68, effective October 13, 1994; 23 SDR 38, effective September 26, 1996; 28 SDR 166, effective June 12, 2002; repealed, 34 SDR 68, effective September 12, 2007.<o:p></o:p></span></font></p> <font size=3 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<![endif]--><!--[if gte mso 9]><xml> <o:shapedefaults v:ext="edit" spidmax="1026"/> </xml><![endif]--><!--[if gte mso 9]><xml> <o:shapelayout v:ext="edit"> <o:idmap v:ext="edit" data="1"/> </o:shapelayout></xml><![endif]--> </head> <body lang=EN-US style='tab-interval:.5in'> <div class=Section1> <p class=MsoNormal style='tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal style='tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal style='tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal style='tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal style='tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal style='tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal style='tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal style='tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal style='tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal style='tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal style='tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal style='tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'>DEPARTMENT OF SOCIAL SERVICES<o:p></o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'>OFFICE OF MEDICAL SERVICES<o:p></o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'>LIST OF PHYSICIAN LABORATORY PROCEDURES<o:p></o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'>Chapter 67:16:02<o:p></o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'>APPENDIX B<o:p></o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'>SEE:<span style='mso-spacerun:yes'>&nbsp; </span>&#167; 67:16:02:03<o:p></o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'>(Repealed)<o:p></o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal style='text-align:justify;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><span style='mso-tab-count:1'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span><b style='mso-bidi-font-weight:normal'><span style='font-weight:bold;mso-bidi-font-weight: normal'>Source:</span></b> 16 SDR 64, effective October 8, 1989; 16 SDR 227, effective June 25, 1990; 17 SDR 200, effective July 1, 1991; 19 SDR 82, effective December 7, 1992; 20 SDR 28, effective August 31, 1993; 21 SDR 68, effective October 13, 1994; 28 SDR 166, effective June 12, 2002; repealed, 34 SDR 68, effective September 12, 2007.<o:p></o:p></span></font></p> <font size=2 face=Times><span style='font-size:10.0pt;font-family:Times; mso-fareast-font-family:"Times New Roman";mso-bidi-font-family:"Times New Roman"; mso-ansi-language:EN-US;mso-fareast-language:EN-US;mso-bidi-language:AR-SA'><br clear=all style='mso-special-character:line-break;page-break-before:always'> </span></font> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=2 face=Times><span style='font-size:10.0pt'><o:p>&nbsp;</o:p></span></font></p> </div> </body> </html> <br /><hr><br /><html xmlns:v="urn:schemas-microsoft-com:vml" xmlns:o="urn:schemas-microsoft-com:office:office" xmlns:w="urn:schemas-microsoft-com:office:word" xmlns="http://www.w3.org/TR/REC-html40"> <head> <title>Rule 67:16:02:0C Physician Medical Procedures -- Medicare Maximum Allowance.</title> <META NAME="Keywords" Content="Administrative Rules 67:16:02:0C"> <META NAME="Description" Content="Administrative Rules 67:16:02:0C Physician Medical Procedures -- Medicare Maximum Allowance."> <meta http-equiv=Content-Type content="text/html; charset=windows-1252"> <meta name=ProgId content=Word.Document> <meta name=Generator content="Microsoft Word 10"> <meta name=Originator content="Microsoft Word 10"> <link rel=File-List href="6716020000c00e_files/filelist.xml"> <title>DEPARTMENT OF SOCIAL SERVICES</title> <!--[if gte mso 9]><xml> <o:DocumentProperties> <o:Author>lrpr14296</o:Author> <o:LastAuthor>lrpr14296</o:LastAuthor> <o:Revision>2</o:Revision> <o:TotalTime>4</o:TotalTime> <o:LastPrinted>2008-01-18T15:55:00Z</o:LastPrinted> <o:Created>2008-01-22T14:29:00Z</o:Created> <o:LastSaved>2008-01-22T14:29:00Z</o:LastSaved> <o:Pages>2</o:Pages> <o:Words>86</o:Words> <o:Characters>492</o:Characters> <o:Company>State of South Dakota</o:Company> <o:Lines>4</o:Lines> <o:Paragraphs>1</o:Paragraphs> <o:CharactersWithSpaces>577</o:CharactersWithSpaces> <o:Version>10.6830</o:Version> </o:DocumentProperties> <o:OfficeDocumentSettings> <o:DoNotRelyOnCSS/> </o:OfficeDocumentSettings> </xml><![endif]--><!--[if gte mso 9]><xml> <w:WordDocument> <w:GrammarState>Clean</w:GrammarState> <w:DisplayHorizontalDrawingGridEvery>0</w:DisplayHorizontalDrawingGridEvery> <w:DisplayVerticalDrawingGridEvery>0</w:DisplayVerticalDrawingGridEvery> <w:UseMarginsForDrawingGridOrigin/> <w:Compatibility> 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9]><xml> <o:shapedefaults v:ext="edit" spidmax="1026"/> </xml><![endif]--><!--[if gte mso 9]><xml> <o:shapelayout v:ext="edit"> <o:idmap v:ext="edit" data="1"/> </o:shapelayout></xml><![endif]--> </head> <body lang=EN-US style='tab-interval:.5in'> <div class=Section1> <p class=MsoNormal style='tab-stops:right 1.5in left 1.8in right 2.5in left 2.8in right 3.5in left 3.8in right 4.5in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal style='tab-stops:right 1.5in left 1.8in right 2.5in left 2.8in right 3.5in left 3.8in right 4.5in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal style='tab-stops:right 1.5in left 1.8in right 2.5in left 2.8in right 3.5in left 3.8in right 4.5in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal style='tab-stops:right 1.5in left 1.8in right 2.5in left 2.8in right 3.5in left 3.8in right 4.5in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal style='tab-stops:right 1.5in left 1.8in right 2.5in left 2.8in right 3.5in left 3.8in right 4.5in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal style='tab-stops:right 1.5in left 1.8in right 2.5in left 2.8in right 3.5in left 3.8in right 4.5in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal style='tab-stops:right 1.5in left 1.8in right 2.5in left 2.8in right 3.5in left 3.8in right 4.5in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal style='tab-stops:right 1.5in left 1.8in right 2.5in left 2.8in right 3.5in left 3.8in right 4.5in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal style='tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal style='tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal style='tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal style='tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'>DEPARTMENT OF SOCIAL SERVICES<o:p></o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'>OFFICE OF MEDICAL SERVICES<o:p></o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'>PHYSICIAN MEDICAL PROCEDURES -- MEDICARE MAXIMUM ALLOWANCES<o:p></o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'>Chapter 67:16:02<o:p></o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'>APPENDIX C<o:p></o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'>SEE:<span style='mso-spacerun:yes'>&nbsp; </span>&#167; 67:16:02:03<o:p></o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'>(Repealed)<o:p></o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal style='text-align:justify;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><span style='mso-tab-count:1'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span><b style='mso-bidi-font-weight:normal'><span style='font-weight:bold;mso-bidi-font-weight: normal'>Source:</span></b> 16 SDR 64, effective October 8, 1989; 17 SDR 200, effective July 1, 1991; 19 SDR 82, effective December 7, 1992; 20 SDR 28, effective August 31, 1993; 21 SDR 68, effective October 13, 1994; 22 SDR 94, effective January 10, 1996; 23 SDR 38, effective September 26, 1996; 28 SDR 166, effective June 12, 2002; repealed, 34 SDR 68, effective September 12, 2007.<o:p></o:p></span></font></p> <font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman";mso-fareast-font-family:"Times New Roman"; mso-ansi-language:EN-US;mso-fareast-language:EN-US;mso-bidi-language:AR-SA'><br clear=all style='mso-special-character:line-break;page-break-before:always'> </span></font> <p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size: 12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> </div> </body> </html> <br /><hr><br /><html xmlns:v="urn:schemas-microsoft-com:vml" xmlns:o="urn:schemas-microsoft-com:office:office" xmlns:w="urn:schemas-microsoft-com:office:word" xmlns="http://www.w3.org/TR/REC-html40"> <head> <title>Rule 67:16:02:0D List of Modifier Codes for Physician Services.</title> <META NAME="Keywords" Content="Administrative Rules 67:16:02:0D"> <META NAME="Description" Content="Administrative Rules 67:16:02:0D List of Modifier Codes for Physician Services."> <meta http-equiv=Content-Type content="text/html; charset=windows-1252"> <meta name=ProgId content=Word.Document> <meta name=Generator content="Microsoft Word 10"> <meta name=Originator content="Microsoft Word 10"> <link rel=File-List href="6716020000d00e_files/filelist.xml"> <title>DEPARTMENT OF SOCIAL SERVICES</title> <!--[if gte mso 9]><xml> <o:DocumentProperties> <o:Author>lrpr14296</o:Author> <o:LastAuthor>lrpr14296</o:LastAuthor> <o:Revision>2</o:Revision> <o:TotalTime>4</o:TotalTime> <o:Created>2007-09-12T13:29:00Z</o:Created> <o:LastSaved>2007-09-12T13:29:00Z</o:LastSaved> <o:Pages>2</o:Pages> <o:Words>53</o:Words> <o:Characters>308</o:Characters> <o:Company>State of South Dakota</o:Company> <o:Lines>2</o:Lines> <o:Paragraphs>1</o:Paragraphs> <o:CharactersWithSpaces>360</o:CharactersWithSpaces> <o:Version>10.6830</o:Version> </o:DocumentProperties> <o:OfficeDocumentSettings> <o:DoNotRelyOnCSS/> </o:OfficeDocumentSettings> </xml><![endif]--><!--[if gte mso 9]><xml> 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3.2in 4.1in 5.0in 6.0in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal style='tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal style='tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal style='tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal style='tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal style='tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal style='tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal style='tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal style='tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal style='tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal style='tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal style='tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'>DEPARTMENT OF SOCIAL SERVICES<o:p></o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'>OFFICE OF MEDICAL SERVICES<o:p></o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'>LIST OF MODIFIER CODES FOR PHYSICIAN SERVICES<o:p></o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'>Chapter 67:16:02<o:p></o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'>APPENDIX D<o:p></o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'>Transferred to &#167;&nbsp;67:16:02:03.03<o:p></o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal style='text-align:justify;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><span style='mso-tab-count:1'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span><b style='mso-bidi-font-weight:normal'><span style='font-weight:bold;mso-bidi-font-weight: normal'>Source:</span></b> 17 SDR 200, effective July 1, 1991; 23 SDR 38, effective September 26, 1996; transferred to &#167;&nbsp;67:16:02:03.03, 34 SDR 68, effective September 12, 2007.<o:p></o:p></span></font></p> <font size=2 face=Times><span style='font-size:10.0pt;font-family:Times; mso-fareast-font-family:"Times New Roman";mso-bidi-font-family:"Times New Roman"; mso-ansi-language:EN-US;mso-fareast-language:EN-US;mso-bidi-language:AR-SA'><br clear=all style='mso-special-character:line-break;page-break-before:always'> </span></font> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=2 face=Times><span style='font-size:10.0pt'><o:p>&nbsp;</o:p></span></font></p> </div> </body> </html> <br /><hr><br /><html xmlns:v="urn:schemas-microsoft-com:vml" xmlns:o="urn:schemas-microsoft-com:office:office" xmlns:w="urn:schemas-microsoft-com:office:word" xmlns="http://www.w3.org/TR/REC-html40"> <head> <title>Rule 67:16:02:0E Clozaril Enrollment Information Form.</title> <META NAME="Keywords" Content="Administrative Rules 67:16:02:0E"> <META NAME="Description" Content="Administrative Rules 67:16:02:0E Clozaril Enrollment Information Form."> <meta http-equiv=Content-Type content="text/html; charset=windows-1252"> <meta name=ProgId content=Word.Document> <meta name=Generator content="Microsoft Word 10"> <meta name=Originator content="Microsoft Word 10"> <link rel=File-List href="6716020000e00e_files/filelist.xml"> <title>DEPARTMENT OF SOCIAL SERVICES</title> <!--[if gte mso 9]><xml> <o:DocumentProperties> <o:Author>lrpr14533</o:Author> <o:LastAuthor>lrpr14296</o:LastAuthor> <o:Revision>2</o:Revision> <o:TotalTime>3</o:TotalTime> <o:Created>2008-01-22T14:29:00Z</o:Created> <o:LastSaved>2008-01-22T14:29:00Z</o:LastSaved> <o:Pages>2</o:Pages> <o:Words>48</o:Words> <o:Characters>277</o:Characters> <o:Company>State of South Dakota</o:Company> <o:Lines>2</o:Lines> <o:Paragraphs>1</o:Paragraphs> <o:CharactersWithSpaces>324</o:CharactersWithSpaces> <o:Version>10.6830</o:Version> </o:DocumentProperties> </xml><![endif]--><!--[if gte 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</head> <body lang=EN-US style='tab-interval:.5in'> <div class=Section1> <p class=MsoNormal style='tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'>DEPARTMENT OF SOCIAL SERVICES<o:p></o:p></span></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'>OFFICE OF MEDICAL SERVICES<o:p></o:p></span></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'>CLOZARIL ENROLLMENT INFORMATION FORM<o:p></o:p></span></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'>Chapter 67:16:02<o:p></o:p></span></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'>APPENDIX E<o:p></o:p></span></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'>SEE:<span style='mso-spacerun:yes'>&nbsp; </span>&#167; 67:16:02:05.04<o:p></o:p></span></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'>(Repealed)<o:p></o:p></span></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal align=center style='text-align:center;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='text-align:justify;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><span style='mso-tab-count:1'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span><b style='mso-bidi-font-weight:normal'>Source:</b> 18 SDR 50, effective September 15, 1991; 26 SDR 168, effective July 1, 2000; <span class=GramE>repealed</span>, 31 SDR 214, effective July 6, 2005.<o:p></o:p></span></p> <span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"; mso-fareast-font-family:"Times New Roman";mso-ansi-language:EN-US;mso-fareast-language: EN-US;mso-bidi-language:AR-SA'><br clear=all style='mso-special-character:line-break; page-break-before:always'> </span> <p class=MsoNormal style='text-align:justify;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p> </div> </body> </html> <br /><hr><br /><html> <head> <title>Rule 67:16:02:01 Definitions.</title> <META NAME="Keywords" Content="Administrative Rules 67:16:02:01"> <META NAME="Description" Content="Administrative Rules 67:16:02:01 Definitions."> <meta http-equiv=Content-Type content="text/html; charset=windows-1252"> <meta name=Generator content="Microsoft Word 15 (filtered)"> <style> <!-- /* Font Definitions */ @font-face {font-family:"Cambria Math"; panose-1:2 4 5 3 5 4 6 3 2 4;} @font-face {font-family:Times; panose-1:2 2 6 3 5 4 5 2 3 4;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {margin:0in; margin-bottom:.0001pt; font-size:10.0pt; font-family:"Times",serif; color:black;} p.MsoBodyText, li.MsoBodyText, div.MsoBodyText {mso-style-link:"Body Text Char"; margin:0in; margin-bottom:.0001pt; text-align:justify; font-size:12.0pt; font-family:"Times New Roman",serif; color:black;} a:link, span.MsoHyperlink {color:blue; text-decoration:underline;} a:visited, span.MsoHyperlinkFollowed {color:#954F72; text-decoration:underline;} span.BodyTextChar {mso-style-name:"Body Text Char"; mso-style-link:"Body Text"; font-family:"Times New Roman",serif;} .MsoChpDefault {font-size:10.0pt; color:black;} @page WordSection1 {size:8.5in 11.0in; margin:1.0in 1.25in 1.0in 1.25in;} div.WordSection1 {page:WordSection1;} --> </style> </head> <body lang=EN-US link=blue vlink="#954F72"> <div class=WordSection1> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>67:16:02:01.&nbsp;&nbsp;Definitions.</b> Terms used in this chapter mean:</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (1)&nbsp;&nbsp;&quot;Clinical nurse specialist,&quot; an individual who is licensed under SDCL <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=36-9-85">36-9-85</A> to perform the functions contained in SDCL 36-9-87</span><span style='font-size: 12.0pt;font-family:"Times New Roman",serif'>, or an individual licensed or certified in another state to perform those functions</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoBodyText>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (2)&nbsp;&nbsp;&quot;Medical and other health services,&quot; any of the items or services covered in this chapter under the sections on physician's and other health services;</p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (3)&nbsp;&nbsp;&quot;Nurse anesthetist,&quot; an individual who is qualified under SDCL <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=36-9-30.1">36-9-30.1</A> to perform the functions contained in SDCL 36-9-3.1, or an individual licensed or certified in another state to perform those functions;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (4)&nbsp;&nbsp;&quot;Nurse midwife,&quot; an individual who is qualified under SDCL chapter <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=36-9A">36-9A</A> to perform the functions contained in SDCL 36-9A-13, or an individual licensed or certified in another state to perform those functions;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (5)&nbsp;&nbsp;&quot;Nurse practitioner,&quot; an individual who is qualified under SDCL chapter <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=36-9A">36-9A</A> to perform the functions contained in SDCL 36-9A-12</span><span style='font-size: 12.0pt;font-family:"Times New Roman",serif'>, or an individual licensed or certified in another state to perform those functions</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (6)&nbsp;&nbsp;&quot;Physician,&quot; a person licensed as a physician in accordance with the provisions of SDCL chapter <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=36-4">36-4</A> and qualified to provide medical and other health services under this chapter, or an individual licensed or certified in another state to perform those functions;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (7)&nbsp;&nbsp;&quot;Physician assistant,&quot; an individual qualified and certified under the provisions of SDCL chapter <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=36-4A">36-4A</A></span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> to perform the functions contained in SDCL 36-4A-26.l, or an individual licensed or certified in another state to perform those functions</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (8)&nbsp;&nbsp;&quot;Postoperative management only,&quot; performance of postoperative management by one physician</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> or other licensed practitioner</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> after another physician</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> </span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>or other licensed practitioner has performed the surgical procedure;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (9)&nbsp;&nbsp;&quot;Preoperative management only,&quot; performance of preoperative care and evaluation by one physician</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> </span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>or other licensed practitioner before another physician or other licensed practitioner</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> </span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>performs the surgical procedure;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (10)&nbsp;&nbsp;&quot;Procedure codes,&quot; identifying numbers used in the submission of claims for medical, surgical, and diagnostic services;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (11)&nbsp;&nbsp;&quot;Reduced services,&quot; </span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>an</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> instance in which a service or procedure is partially reduced or eliminated at the physician</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> </span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>or other licensed practitioner</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>'s</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> request;</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> and</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (12)&nbsp;&nbsp;&quot;Unusual services,&quot; </span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>an instance in</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> which the service provided is greater than that usually required for the procedure.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>Source:</b> SL 1975, ch 16, &#167;&nbsp;1; 7 SDR 66, 7 SDR 89, effective July 1, 1981; 16 SDR 64, effective October 8, 1989; 16 SDR 234, effective July 2, 1990; 18 SDR 50, effective September 15, 1991; 19 SDR 165, effective May 3, 1993; 24 SDR 86, effective January 1, 1998; 34 SDR 68, effective September 12, 2007; 44 SDR 94, effective December 4, 2017.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&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(1).</A></span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&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(1)</A></span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>(2)</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> </div> </body> </html> <br /><hr><br /><html> <head> <title>Rule 67:16:02:01.01 Fee schedules for physician services.</title> <META NAME="Keywords" Content="Administrative Rules 67:16:02:01.01"> <META NAME="Description" Content="Administrative Rules 67:16:02:01.01 Fee schedules for physician services."> <meta http-equiv=Content-Type content="text/html; charset=windows-1252"> <meta name=Generator content="Microsoft Word 15 (filtered)"> <style> <!-- /* Font Definitions */ @font-face {font-family:"Cambria Math"; panose-1:2 4 5 3 5 4 6 3 2 4;} @font-face {font-family:Times; panose-1:2 2 6 3 5 4 5 2 3 4;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {margin:0in; margin-bottom:.0001pt; font-size:10.0pt; font-family:"Times",serif; color:black;} a:link, span.MsoHyperlink {color:blue; text-decoration:underline;} a:visited, span.MsoHyperlinkFollowed {color:#954F72; text-decoration:underline;} .MsoChpDefault {font-size:10.0pt; color:black;} @page WordSection1 {size:8.5in 11.0in; margin:1.0in 1.0in 1.0in 1.0in;} div.WordSection1 {page:WordSection1;} --> </style> </head> <body lang=EN-US link=blue vlink="#954F72"> <div class=WordSection1> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>67:16:02:01.01.&nbsp;&nbsp;Fee schedules for physician services.</b> Fee schedules for services provided under this chapter are available on the department's fee schedule website. When computing the rate of reimbursement for physician services, the department uses the following fee schedules:</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (1)&nbsp;&nbsp;Nonlaboratory fee schedule; and</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (2)&nbsp;&nbsp;Laboratory fee schedule.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; The fee schedules are subject to review and amendment by the department. A provider may request that the department review a particular reimbursement rate for possible adjustment or request the inclusion or exclusion of a particular code from the list. When reviewing the requests, the department shall review paid claims information, Medicare fee schedules, national coding lists, and documentation submitted by the provider or the associated medical professional organization to determine whether a change is warranted.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>Source:</b> 34 SDR 68, effective September 12, 2007; 42 SDR 51, effective October 13, 2015; 44 SDR 94, effective December 4, 2017.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&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</A></span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>(1)(2)</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&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</A></span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>(1)(2)</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>, 28-6-1.1.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> </div> </body> </html> <br /><hr><br /><html> <head> <title>Rule 67:16:02:02 Repealed.</title> <META NAME="Keywords" Content="Administrative Rules 67:16:02:02"> <META NAME="Description" Content="Administrative Rules 67:16:02:02 Repealed."> <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>67:16:02:02.&nbsp;&nbsp;Provider agreement.</b> Repealed.</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> SL 1975, ch 16, §&nbsp;1; repealed, 7 SDR 66, 7 SDR 89, effective July 1, 1981; cross-reference added, 16 SDR 234, effective July 2, 1990.</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>Cross-Reference:</b> Participating provider, §&nbsp;67:16:33:02.</font></p> <p><font size=3 face="Times New Roman">&nbsp;</font></p> </div> </body> </html> <br /><hr><br /><html xmlns="http://www.w3.org/1999/xhtml"><head><meta charset="UTF-8" /><title></title><meta name="Generator" content="PowerTools for Open XML" /><style>p.s454f6c95-981a-4f56-98dd-63ad22d07e3fP0 { 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.s454f6c95-981a-4f56-98dd-63ad22d07e3fC0 { color: #000000; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.s454f6c95-981a-4f56-98dd-63ad22d07e3fC0-000000 { color: #0000FF; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.s454f6c95-981a-4f56-98dd-63ad22d07e3fC0-000001 { color: #000000; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.s454f6c95-981a-4f56-98dd-63ad22d07e3fC0-000002 { color: #0000FF; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.s454f6c95-981a-4f56-98dd-63ad22d07e3f000003 { color: #000000; background: white; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } </style></head><body><div><p dir="ltr" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">    </span><a href="https://sdlegislature.gov/Rules?Rule=67:16:02:03"><span style="white-space: pre-wrap;" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0-000000">67:16:02:03</span></a><span style="white-space: pre-wrap;" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0-000001">.  Rate of payment.</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0"> When computing the rate of reimbursement, the department uses the fee schedules established under the provisions of § </span><a href="https://sdlegislature.gov/Rules?Rule=67:16:02:01.01"><span style="white-space: pre-wrap;" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0-000002">67:16:02:01.01</span></a><span style="white-space: pre-wrap;" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">. A claim submitted under this chapter must be submitted at the p</span><span style="white-space: pre-wrap;" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">rovider</span><span style="white-space: pre-wrap;" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">'s usual and customary charge. Payment is limited to the lesser of the p</span><span style="white-space: pre-wrap;" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">rovider</span><span style="white-space: pre-wrap;" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">'s usual and customary charge or the payment established under the following provisions:</span></p><p dir="ltr" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3f000003"> </span></p><p dir="ltr" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">    (1)  For nonlaboratory procedures listed in the applicable fee schedule, the amount specified in the fee schedule;</span></p><p dir="ltr" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3f000003"> </span></p><p dir="ltr" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">    (2)  </span><span style="white-space: pre-wrap;" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">If no fee is specified for</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0"> nonlaboratory procedures,</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0"> payment is limited to forty</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0"> percent of the usual and customary charge;</span></p><p dir="ltr" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3f000003"> </span></p><p dir="ltr" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">    (3)  For laboratory procedures listed in the applicable fee schedule, the amount specified in the fee schedule;</span></p><p dir="ltr" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3f000003"> </span></p><p dir="ltr" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">    (4)  </span><span style="white-space: pre-wrap;" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">If no fee is specified for</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0"> laboratory procedures, </span><span style="white-space: pre-wrap;" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">payment is limited to sixty</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0"> percent of the p</span><span style="white-space: pre-wrap;" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">rovider</span><span style="white-space: pre-wrap;" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">'s usual and customary charge;</span></p><p dir="ltr" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3f000003"> </span></p><p dir="ltr" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">    (5)  For anesthesia services furnished by a physician, the fee established in the fee schedule on the department's fee schedule website. Time must be reported in </span><span style="white-space: pre-wrap;" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">fifteen</span><span style="white-space: pre-wrap;" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">-minute units beginning from the time the physician begins to prepare the patient for induction and ending when the patient is placed under postoperative supervision and the physician is no longer in personal attendance;</span></p><p dir="ltr" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3f000003"> </span></p><p dir="ltr" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">    (6)  For anesthesia services furnished by a nurse anesthetist, the fee established in the fee schedule on the department's fee schedule website, computed according to subdivision (5) of this section </span><span style="white-space: pre-wrap;" xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">for </span><span style="white-space: pre-wrap;" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">as long as the anesthetist is assisting the physician in the care of the patient;</span></p><p dir="ltr" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3f000003"> </span></p><p dir="ltr" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">    (7)  For medical supplies incidental to the professional service provided, the fee established in the nonlaboratory fee schedule. If </span><span style="white-space: pre-wrap;" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">no</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0"> fee is </span><span style="white-space: pre-wrap;" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">specified for the medical supplies, payment is limited to ninety p</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">ercent of the </span><span style="white-space: pre-wrap;" xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">lesser of the </span><span style="white-space: pre-wrap;" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">p</span><span style="white-space: pre-wrap;" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">rovider</span><span style="white-space: pre-wrap;" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">'s usual and customary charge</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0"> or the manufacturer's suggested retail price</span><span style="white-space: pre-wrap;" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">;</span></p><p dir="ltr" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3f000003"> </span></p><p dir="ltr" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">    (8)  For injection and immunization procedures, the amount established in the nonlaboratory fee schedule. If </span><span style="white-space: pre-wrap;" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">no fee is specified</span><span style="white-space: pre-wrap;" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">,</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0"> payment is limited to forty</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0"> percent of the p</span><span style="white-space: pre-wrap;" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">rovider</span><span style="white-space: pre-wrap;" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">'s usual and customary charge; and</span></p><p dir="ltr" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3f000003"> </span></p><p dir="ltr" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">    (9)  For prosthetic or orthotic devices or medical equipment provided by a physician, the fee established in the nonlaboratory fee schedule. If </span><span style="white-space: pre-wrap;" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">no</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0"> fee is </span><span style="white-space: pre-wrap;" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">specified</span><span style="white-space: pre-wrap;" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">,</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0"> payment is limited to seventy-five</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0"> percent of the</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0"> lesser of the</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0"> p</span><span style="white-space: pre-wrap;" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">rovider</span><span style="white-space: pre-wrap;" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">'s usual and customary charge</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0"> or the manufacturer's suggested retail price</span><span style="white-space: pre-wrap;" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">.</span></p><p dir="ltr" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3f000003"> </span></p><p dir="ltr" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">    </span><span style="white-space: pre-wrap;" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0-000001">Source:</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0"> SL 1975, ch 16, § 1; 7 SDR 66, 7 SDR 89, effective July 1, 1981; 16 SDR 64, effective October 8, 1989; 16 SDR 214, effective June 11, 1990; 16 SDR 234, effective July 2, 1990; 17 SDR 200, effective July 1, 1991; 18 SDR 78, effective November 4, 1991; 18 SDR 107, effective December 29, 1991; 20 SDR 28, effective August 31, 1993; 26 SDR 168, effective July 1, 2000; 34 SDR 68, effective September 12, 2007; 37 SDR 236, effective June 28, 2011; 37 SDR 236, adopted June 8, 2011, effective July 1, 2012; 40 SDR 229, effective June 30, 2014; 42 SDR 51, effective October 13, 2015; 44 SDR 94, effective December 4, 2017</span><span style="white-space: pre-wrap;" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">; 50 SDR 63, effective November 27, 2023</span><span style="white-space: pre-wrap;" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">.</span></p><p dir="ltr" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">    </span><span style="white-space: pre-wrap;" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0-000001">General Authority:</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0"> SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=28-6-1"><span style="white-space: pre-wrap;" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0-000002">28-6-1</span></a><span style="white-space: pre-wrap;" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">.</span></p><p dir="ltr" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">    </span><span style="white-space: pre-wrap;" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0-000001">Law Implemented:</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0"> SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=28-6-1"><span style="white-space: pre-wrap;" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0-000002">28-6-1</span></a><span style="white-space: pre-wrap;" xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">, </span><a href="https://sdlegislature.gov/Statutes?Statute=28-6-1"><span style="white-space: pre-wrap;" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0-000002">28-6-1</span></a><span style="white-space: pre-wrap;" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">.1</span><span style="white-space: pre-wrap;" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fC0">.</span></p><p dir="ltr" class="s454f6c95-981a-4f56-98dd-63ad22d07e3fP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s454f6c95-981a-4f56-98dd-63ad22d07e3f000003"> </span></p></div></body></html><br /><hr><br /><html> <head> <title>Rule 67:16:02:03.01 Reimbursement for multiple surgeries.</title> <META NAME="Keywords" Content="Administrative Rules 67:16:02:03.01"> <META NAME="Description" Content="Administrative Rules 67:16:02:03.01 Reimbursement for multiple surgeries."> <meta http-equiv=Content-Type content="text/html; charset=windows-1252"> <meta name=Generator content="Microsoft Word 15 (filtered)"> <style> <!-- /* Font Definitions */ @font-face {font-family:"Cambria Math"; panose-1:2 4 5 3 5 4 6 3 2 4;} @font-face {font-family:Calibri; panose-1:2 15 5 2 2 2 4 3 2 4;} @font-face {font-family:Times; panose-1:2 2 6 3 5 4 5 2 3 4;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {margin:0in; margin-bottom:.0001pt; font-size:10.0pt; font-family:"Times",serif; color:black;} a:link, span.MsoHyperlink {color:blue; text-decoration:underline;} a:visited, span.MsoHyperlinkFollowed {color:#954F72; text-decoration:underline;} .MsoChpDefault {font-size:10.0pt; font-family:"Calibri",sans-serif; color:black;} @page WordSection1 {size:8.5in 11.0in; margin:49.7pt 1.0in 49.7pt 63.35pt;} div.WordSection1 {page:WordSection1;} --> </style> </head> <body lang=EN-US link=blue vlink="#954F72"> <div class=WordSection1> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>67:16:02:03.01.&nbsp;&nbsp;Reimbursement for multiple surgeries.</b> The department shall apply the provisions of this section and the fee schedules established under the provisions of &#167;&nbsp;67:16:02:01.01 to calculate the rate of reimbursement if multiple surgical procedures are performed. Payment for multiple surgical procedures performed during the same operating session is limited to the lesser of the provider's usual and customary charge or the amount specified in the following:</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (1)&nbsp;&nbsp;Full allowable reimbursement for the primary surgical procedure and for a surgical procedure which cannot stand alone but which is performed as a part of a primary surgical procedure. All other procedures, except for bilateral procedures, performed during the same operating session require the use of the modifier 51 and are payable under the provisions of subdivision (3) of this section;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (2)&nbsp;&nbsp;For surgical procedures using</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> the</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> modifier 50 (bilateral procedure), 150 percent of the fee specified in the applicable fee schedule or, if no fee is listed, 40 percent of the p</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>rovider</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>'s usual and customary charge;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (3)&nbsp;&nbsp;For secondary surgical procedures using </span><span style='font-size:12.0pt;font-family: "Times New Roman",serif'>the</span><span style='font-size:12.0pt;font-family: "Times New Roman",serif'> modifier 51 (multiple procedures performed on the same day), 50 percent of the fee specified in the applicable fee schedule or, if no fee is listed, 30 percent of the p</span><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>rovider</span><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>'s usual and customary charge; and</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (4)&nbsp;&nbsp;No reimbursement for surgical procedures that are incidental to the primary procedure, as determined by the department.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>Source:</b> 9 SDR 164, effective June 30, 1983; 17 SDR 200, effective July 1, 1991; 18 SDR 78, effective November 4, 1991; 19 SDR 26, effective August 23, 1992; 19 SDR 165, effective May 3, 1993; 20 SDR 28, effective August 31, 1993; 23 SDR 38, effective September 26, 1996; 34 SDR 68, effective September 12, 2007; 37 SDR 236, effective June 28, 2011; 37 SDR 236, adopted June 8, 2011, effective July 1, 2012; 44 SDR 94, effective December 4, 2017.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&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</A></span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>(1)(2)</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&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</A></span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>(1)(2)</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> </div> </body> </html> <br /><hr><br /><html> <head> <title>Rule 67:16:02:03.02 Reimbursement for services containing modifier codes.</title> <META NAME="Keywords" Content="Administrative Rules 67:16:02:03.02"> <META NAME="Description" Content="Administrative Rules 67:16:02:03.02 Reimbursement for services containing modifier codes."> <meta http-equiv=Content-Type content="text/html; charset=windows-1252"> <meta name=Generator content="Microsoft Word 15 (filtered)"> <style> <!-- /* Font Definitions */ @font-face {font-family:"Cambria Math"; panose-1:2 4 5 3 5 4 6 3 2 4;} @font-face {font-family:Times; panose-1:2 2 6 3 5 4 5 2 3 4;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {margin:0in; margin-bottom:.0001pt; font-size:10.0pt; font-family:"Times",serif; color:black;} a:link, span.MsoHyperlink {color:blue; text-decoration:underline;} a:visited, span.MsoHyperlinkFollowed {color:#954F72; text-decoration:underline;} .MsoChpDefault {font-size:10.0pt; color:black;} @page WordSection1 {size:8.5in 11.0in; margin:1.0in 1.0in 1.0in 1.0in;} div.WordSection1 {page:WordSection1;} --> </style> </head> <body lang=EN-US link=blue vlink="#954F72"> <div class=WordSection1> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>67:16:02:03.02.&nbsp;&nbsp;Reimbursement for services containing modifier codes.</b> Modifier codes which must be used if applicable are listed in &#167;&nbsp;67:16:02:03.03. When computing the rate of reimbursement, the department uses the fee schedules established under the provisions of &#167;&nbsp;67:16:02:01.01. Payment for a service listed with a modifier code is limited to the lesser of the p</span><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>rovider</span><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>'s usual and customary charge or the payment established according to the following:</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (1)&nbsp;&nbsp;For a procedure listed in either fee schedule which is reported with the addition of the modifier 22, 125 percent of the established fee. If the procedure is not listed, 40 percent of the p</span><span style='font-size:12.0pt;font-family: "Times New Roman",serif'>rovider</span><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>'s usual and customary charge;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (2)&nbsp;&nbsp;For a procedure listed in either fee schedule which is reported with the addition of the modifier, 100 percent of the established fee. If the procedure is not listed, 40 percent of the p</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>rovider</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>'s usual and customary charge;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (3)&nbsp;&nbsp;For a procedure listed in either fee schedule which is a combination of a </span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>professional</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> component and a technical component and which is for the </span><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>professional</span><span style='font-size: 12.0pt;font-family:"Times New Roman",serif'> component only and is reported with the addition of the modifier, 30 percent of the established fee for the laboratory procedure and 40 percent of the established fee for the nonlaboratory procedure. If the procedure is not listed in either fee schedule, 40 percent of the p</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>rovider</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>'s usual and customary charge;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (4)&nbsp;&nbsp;For a procedure listed in the nonlaboratory fee schedule which is reported with the addition of the modifier 47, the rate listed on the department's fee schedule website;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (5)&nbsp;&nbsp;For a procedure listed in the nonlaboratory fee schedule which is reported with the addition of the modifier 50, 150 percent of the established fee. If no fee is listed, 40 percent of the p</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>rovider</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>'s usual and customary charge;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (6)&nbsp;&nbsp;For a procedure listed in the nonlaboratory fee schedule which is reported with the addition of the modifier 51, 50 percent of the established fee. If no fee is listed, 30 percent of the p</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>rovider</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>'s usual and customary charge;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (7)&nbsp;&nbsp;For a procedure listed in either fee schedule which is reported with the addition of the modifier 52, 75 percent of the established fee. If the procedure is not listed in either fee schedule, 40 percent of the p</span><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>rovider</span><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>'s usual and customary charge;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (8)&nbsp;&nbsp;For a procedure listed in either fee schedule which is reported with the addition of the modifier 53, 50 percent of the established fee. If no fee is listed, 40 percent of the p</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>rovider</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>'s usual and customary charge;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (9)&nbsp;&nbsp;For a procedure listed in the nonlaboratory fee schedule which is reported with the addition of the modifier 54, 75 percent of the established fee. If the procedure is not listed, 40 percent of the p</span><span style='font-size:12.0pt;font-family: "Times New Roman",serif'>rovider</span><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>'s usual and customary charge;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (10)&nbsp;&nbsp;For a procedure listed in the nonlaboratory fee schedule which is reported with the addition of the modifier 55 or 56, 25 percent of the established fee. If the procedure is not listed, 40 percent of the p</span><span style='font-size:12.0pt;font-family: "Times New Roman",serif'>rovider</span><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>'s usual and customary charge;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (11)&nbsp;&nbsp;For a procedure listed in the nonlaboratory fee schedule which is reported with the addition of the modifier 59, 100 percent of the established fee. If no fee is listed, 30 percent of the p</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>rovider</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>'s usual and customary charge;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (12)&nbsp;&nbsp;For a procedure listed in the nonlaboratory fee schedule which is reported with the addition of the modifier 62, 50 percent of the established fee for each surgeon;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (13)&nbsp;&nbsp;For a procedure listed in the nonlaboratory fee schedule which is reported with the addition of the modifier 73 or 74, 50 percent of the established fee. If no fee is established, 40 percent of the p</span><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>rovider</span><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>'s usual and customary charge;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (14)&nbsp;&nbsp;For a procedure listed in the nonlaboratory fee schedule which is reported with the addition of the modifier 76, 77, 78, or 79, 100 percent of the established fee. If no fee is established, 40 percent of the p</span><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>rovider</span><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>'s usual and customary charge;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (15)&nbsp;&nbsp;For a procedure listed in the nonlaboratory fee schedule which is reported with the addition of the modifier of 80, 81, or 82, 20 percent of the established fee. If the procedure is not listed, 40 percent of the p</span><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>rovider</span><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>'s usual and customary charge;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (16)&nbsp;&nbsp;For a procedure listed in the nonlaboratory fee schedule which is reported with the addition of the modifier of AA, AD, QK, QX, QY, or QZ the rate listed on the department's </span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>fee schedule </span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>website. Time must be reported in 15 minute units beginning from the time the physician</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> or other licensed practitioner</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> begins to prepare the patient for induction and ending when the patient is placed under postoperative supervision and the physician</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> or other licensed practitioner</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> is no longer in personal attendance;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (17)&nbsp;&nbsp;For a procedure listed in either fee schedule which is reported with the addition of the modifier AS, 20 percent of the reimbursement calculated according to &#167;&nbsp;67:16:02:15. If the procedures are not listed in either fee schedule, 40 percent of the reimbursement calculated according to &#167;&nbsp;67:16:02:15;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (18)&nbsp;&nbsp;For a procedure listed in the nonlaboratory fee schedule which is reported with the addition of the modifier SL (state supplied vaccine), payment is limited to the injection only; and</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (19)&nbsp;&nbsp;For a procedure listed in either fee schedule which is reported with the addition of the modifier TC, 70 percent of the established fee for the laboratory procedure and 60 percent of the established fee for the nonlaboratory procedure. If the procedure is not listed in either fee schedule, 40 percent of the p</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>rovider</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>'s usual and customary charge.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>Source:</b> 17 SDR 200, effective July 1, 1991; 19 SDR 165, effective May 3, 1993; 20 SDR 28, effective August 31, 1993; 34 SDR 68, effective September 12, 2007; 35 SDR 49, effective September 10, 2008; 37 SDR 236, effective June 28, 2011; 37 SDR 236, adopted June 8, 2011, effective July 1, 2012; 40 SDR 229, effective June 30, 2014; 42 SDR 51, effective October 13, 2015; 44 SDR 94, effective December 4, 2017.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&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</A></span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>(1)(2)</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&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</A></span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>(1)(2)</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> </div> </body> </html> <br /><hr><br /><html> <head> <title>Rule 67:16:02:03.03 Required modifier codes.</title> <META NAME="Keywords" Content="Administrative Rules 67:16:02:03.03"> <META NAME="Description" Content="Administrative Rules 67:16:02:03.03 Required modifier codes."> <meta http-equiv=Content-Type content="text/html; charset=windows-1252"> <meta name=Generator content="Microsoft Word 15 (filtered)"> <style> <!-- /* Font Definitions */ @font-face {font-family:"Cambria Math"; panose-1:2 4 5 3 5 4 6 3 2 4;} @font-face {font-family:Times; panose-1:2 2 6 3 5 4 5 2 3 4;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {margin:0in; margin-bottom:.0001pt; font-size:10.0pt; font-family:"Times",serif; color:black;} a:link, span.MsoHyperlink {color:blue; text-decoration:underline;} a:visited, span.MsoHyperlinkFollowed {color:#954F72; text-decoration:underline;} .MsoChpDefault {font-size:10.0pt; color:black;} @page WordSection1 {size:8.5in 11.0in; margin:1.0in 1.0in 1.0in 1.0in;} div.WordSection1 {page:WordSection1;} --> </style> </head> <body lang=EN-US link=blue vlink="#954F72"> <div class=WordSection1> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>67:16:02:03.03.&nbsp;&nbsp;Required modifier codes.</b> A modifier</span><span style='font-size:12.0pt;font-family: "Times New Roman",serif'> code</span><span style='font-size:12.0pt;font-family: "Times New Roman",serif'> provides the means by which the reporting p</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>rovider</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> indicates on the claim form that a service or procedure performed was altered by some specific circumstance but not changed in its definition or code. If applicable, modifier codes must be included on the provider's claim for services. A list of authorized modifier codes is available on the department's modifier website.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>Source:</b> 17 SDR 200, effective July 1, 1991; 23 SDR 38, effective September 26, 1996; transferred from Appendix D, chapter 67:16:02, 34 SDR 68, effective September 12, 2007; 40 SDR 122, effective January 7, 2014; 42 SDR 51, effective October 13, 2015; 44 SDR 94, effective December 4, 2017.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&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</A></span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>(1)(2)</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&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</A></span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>(1)(2)</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> </div> </body> </html> <br /><hr><br /><html> <head> <title>Rule 67:16:02:04 Physician's services covered.</title> <META NAME="Keywords" Content="Administrative Rules 67:16:02:04"> <META NAME="Description" Content="Administrative Rules 67:16:02:04 Physician's services covered."> <meta http-equiv=Content-Type content="text/html; charset=windows-1252"> <meta name=Generator content="Microsoft Word 15 (filtered)"> <style> <!-- /* Font Definitions */ @font-face {font-family:"Cambria Math"; panose-1:2 4 5 3 5 4 6 3 2 4;} @font-face {font-family:Times; panose-1:2 2 6 3 5 4 5 2 3 4;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {margin:0in; margin-bottom:.0001pt; font-size:10.0pt; font-family:"Times",serif; color:black;} a:link, span.MsoHyperlink {color:blue; text-decoration:underline;} a:visited, span.MsoHyperlinkFollowed {color:#954F72; text-decoration:underline;} .MsoChpDefault {font-size:10.0pt; color:black;} @page WordSection1 {size:8.5in 11.0in; margin:1.0in 1.0in 1.0in 1.0in;} div.WordSection1 {page:WordSection1;} --> </style> </head> <body lang=EN-US link=blue vlink="#954F72"> <div class=WordSection1> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>67:16:02:04.&nbsp;&nbsp;Physician's services covered.</b> Physician's services covered are limited to the following professional services, which must be medically necessary and provided by a physician</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> or other licensed practitioner</span><span style='font-size:12.0pt;font-family: "Times New Roman",serif'> to a recipient:</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (1)&nbsp;&nbsp;Medical and surgical services;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (2)&nbsp;&nbsp;Services and supplies furnished incidental to the professional services of a physician</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> </span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>or other licensed practitioner;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (3)&nbsp;&nbsp;Psychiatric services;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (4)&nbsp;&nbsp;Drugs and biologicals administered in a physician</span><span style='font-size:12.0pt; font-family:"Times New Roman",serif'> </span><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>or other licensed practitioner</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>'s</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> office which cannot be self-administered;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (5)&nbsp;&nbsp;Routine physical examinations;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (6)&nbsp;&nbsp;Routine visits to a nursing facility, a home and community-based service provider, an intermediate care facility for individuals with intellectual disabilities, or a home and community-based waiver service provider;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (7)&nbsp;&nbsp;Cosmetic surgery when incidental to prompt repair following an accidental injury or for the improvement of the functioning of a malformed body member;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (8)&nbsp;&nbsp;Family planning services;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (9)&nbsp;&nbsp;Pap smears;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (10)&nbsp;&nbsp;Dialysis treatments;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (11)&nbsp;&nbsp;Hysterectomies as authorized under 42 C.F.R. &#167;&#167;&nbsp;441.250 to 441.259, inclusive</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>,</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> </span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>as amended to April 1, 2017</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>; and</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (12)&nbsp;&nbsp;Hyperbaric oxygen therapy if the requirements listed on the department's prior authorization website are met.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>Source:</b> SL 1975, ch 16, &#167;&nbsp;1; 4 SDR 88, effective June 26, 1978; 7 SDR 23, effective September 18, 1980; 7 SDR 66, 7 SDR 89, effective July 1, 1981; 11 SDR 26, effective August 21, 1984; 15 SDR 204, effective July 6, 1989; 16 SDR 234, effective July 2, 1990; 17 SDR 200, effective July 1, 1991; 19 SDR 26, effective August 23, 1992; 20 SDR 144, effective March 10, 1994; 40 SDR 122, effective January 8, 2014; 42 SDR 51, effective October 13, 2015; 44 SDR 94, effective December 4, 2017.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&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</A></span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>(1)(2)</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&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</A></span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>(1)(2)</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>Cross-References:</b></span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Home and community-based services, ch 67:54:04.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; HCBS Waiver operated by the Division of</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> </span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>Adult Services and Aging, ch 67:44:03.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Covered services must be medically necessary, &#167;&nbsp;67:16:01:06.02.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> </div> </body> </html> <br /><hr><br /><html xmlns:v="urn:schemas-microsoft-com:vml" xmlns:o="urn:schemas-microsoft-com:office:office" xmlns:w="urn:schemas-microsoft-com:office:word" xmlns="http://www.w3.org/TR/REC-html40"> <head> <title>Rule 67:16:02:05 Other health services covered.</title> <META NAME="Keywords" Content="Administrative Rules 67:16:02:05"> <META NAME="Description" Content="Administrative Rules 67:16:02:05 Other health services covered."> <meta http-equiv=Content-Type content="text/html; charset=windows-1252"> <meta name=ProgId content=Word.Document> <meta name=Generator content="Microsoft Word 10"> <meta name=Originator content="Microsoft Word 10"> <link rel=File-List href="6716020000500d_files/filelist.xml"> <!--[if gte mso 9]><xml> <o:DocumentProperties> <o:Author>lrpr14533</o:Author> <o:LastAuthor>lrpr14296</o:LastAuthor> <o:Revision>2</o:Revision> <o:TotalTime>0</o:TotalTime> <o:Created>2007-09-12T13:29:00Z</o:Created> <o:LastSaved>2007-09-12T13:29:00Z</o:LastSaved> <o:Pages>1</o:Pages> <o:Words>232</o:Words> <o:Characters>1324</o:Characters> <o:Company>State of South Dakota</o:Company> <o:Lines>11</o:Lines> <o:Paragraphs>3</o:Paragraphs> <o:CharactersWithSpaces>1553</o:CharactersWithSpaces> <o:Version>10.6830</o:Version> </o:DocumentProperties> </xml><![endif]--><!--[if gte mso 9]><xml> <w:WordDocument> <w:GrammarState>Clean</w:GrammarState> <w:Compatibility> <w:BreakWrappedTables/> <w:SnapToGridInCell/> <w:WrapTextWithPunct/> <w:UseAsianBreakRules/> </w:Compatibility> <w:BrowserLevel>MicrosoftInternetExplorer4</w:BrowserLevel> </w:WordDocument> </xml><![endif]--> <style> <!-- /* Font Definitions */ @font-face {font-family:Times; 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font-family:"Times New Roman";} </style> <![endif]--><!--[if gte mso 9]><xml> <o:shapedefaults v:ext="edit" spidmax="1026"/> </xml><![endif]--><!--[if gte mso 9]><xml> <o:shapelayout v:ext="edit"> <o:idmap v:ext="edit" data="1"/> </o:shapelayout></xml><![endif]--> </head> <body lang=EN-US style='tab-interval:.5in'> <div class=Section1> <p class=MsoNormal style='text-align:justify;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><span style='mso-tab-count:1'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span><b style='mso-bidi-font-weight:normal'>67:16:02:05.<span class=GramE>&nbsp;&nbsp;Other</span> health services covered.</b> The other medically necessary health services and supplies covered under the program are limited to the following:<o:p></o:p></span></p> <p class=MsoNormal style='text-align:justify;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='text-align:justify;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><span style='mso-tab-count:1'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span>(1)&nbsp;&nbsp;X rays for diagnostic and treatment purposes;<o:p></o:p></span></p> <p class=MsoNormal style='text-align:justify;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><span style='mso-tab-count:1'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span>(2)&nbsp;&nbsp;Laboratory tests for diagnostic and treatment purposes;<o:p></o:p></span></p> <p class=MsoNormal style='text-align:justify;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><span style='mso-tab-count:1'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span>(3)&nbsp;&nbsp;Prosthetic devices, except dental, including braces, artificial limbs, artificial eyes, augmentative communication devices, items to replace all or part of an internal body organ, and the replacement of such devices required by a change in the patient's condition. An augmentative communication device is covered under the provisions of chapter 67:16:29;<o:p></o:p></span></p> <p class=MsoNormal style='text-align:justify;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><span style='mso-tab-count:1'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span>(4)&nbsp;&nbsp;X-ray, radium, and radioactive isotope therapy, including materials and services of technicians;<o:p></o:p></span></p> <p class=MsoNormal style='text-align:justify;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><span style='mso-tab-count:1'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span>(5)&nbsp;&nbsp;Surgical dressings following surgery;<o:p></o:p></span></p> <p class=MsoNormal style='text-align:justify;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><span style='mso-tab-count:1'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span>(6)&nbsp;&nbsp;Splints, casts, and similar devices;<o:p></o:p></span></p> <p class=MsoNormal style='text-align:justify;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><span style='mso-tab-count:1'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span>(7)&nbsp;&nbsp;Supplies necessary for the use of prosthetic devices or medical equipment payable under the provisions of chapter 67:16:29; and<o:p></o:p></span></p> <p class=MsoNormal style='text-align:justify;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><span style='mso-tab-count:1'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span>(8)&nbsp;&nbsp;Hearing aids, subject to the limits and payment provisions established in chapter 67:16:29.<o:p></o:p></span></p> <p class=MsoNormal style='text-align:justify;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='text-align:justify;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><span style='mso-tab-count:1'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span><b style='mso-bidi-font-weight:normal'>Source:</b> SL 1975, ch 16, &#167;&nbsp;1; 4 SDR 10, effective August 28, 1977; 7 SDR 66, 7 SDR 89, effective July 1, 1981; 9 SDR 164, effective June 30, 1983; 14 SDR 46, effective September 28, 1987; 17 SDR 200, effective July 1, 1991; 19 SDR 26, effective August 23, 1992; 34 SDR 68, effective September 12, 2007.<o:p></o:p></span></p> <p class=MsoNormal style='text-align:justify;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><span style='mso-tab-count:1'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span><b style='mso-bidi-font-weight:normal'>General Authority:</b> SDCL <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=28-6-1">28-6-1.</A><o:p></o:p></span></p> <p class=MsoNormal style='text-align:justify;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><span style='mso-tab-count:1'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span><b style='mso-bidi-font-weight:normal'>Law Implemented:</b> SDCL <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=28-6-1">28-6-1.</A><o:p></o:p></span></p> <p class=MsoNormal style='text-align:justify;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='text-align:justify;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><span style='mso-tab-count:1'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span><b style='mso-bidi-font-weight:normal'>Cross-References:<o:p></o:p></b></span></p> <p class=MsoNormal style='text-align:justify;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><span style='mso-tab-count:1'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span>Medical equipment payable, &#167;&nbsp;67:16:29:02.<o:p></o:p></span></p> <p class=MsoNormal style='text-align:justify;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><span style='mso-tab-count:1'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span>Covered services must be medically necessary, &#167;&nbsp;67:16:01:06.02.<o:p></o:p></span></p> <p class=MsoNormal style='text-align:justify;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p> </div> </body> </html> <br /><hr><br /><html> <head> <title>Rule 67:16:02:05.01 Physical therapy services covered.</title> <META NAME="Keywords" Content="Administrative Rules 67:16:02:05.01"> <META NAME="Description" Content="Administrative Rules 67:16:02:05.01 Physical therapy services covered."> <meta http-equiv=Content-Type content="text/html; charset=windows-1252"> <meta name=Generator content="Microsoft Word 15 (filtered)"> <style> <!-- /* Font Definitions */ @font-face {font-family:"Cambria Math"; panose-1:2 4 5 3 5 4 6 3 2 4;} @font-face {font-family:Times; panose-1:2 2 6 3 5 4 5 2 3 4;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {margin:0in; margin-bottom:.0001pt; font-size:10.0pt; font-family:"Times",serif; color:black;} a:link, span.MsoHyperlink {color:blue; text-decoration:underline;} a:visited, span.MsoHyperlinkFollowed {color:#954F72; text-decoration:underline;} .MsoChpDefault {font-size:10.0pt; color:black;} @page WordSection1 {size:8.5in 11.0in; margin:1.0in 1.25in 1.0in 1.25in;} div.WordSection1 {page:WordSection1;} --> </style> </head> <body lang=EN-US link=blue vlink="#954F72"> <div class=WordSection1> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>67:16:02:05.01.&nbsp;&nbsp;Physical therapy services covered.</b> Physical therapy services which are ordered by a physician</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> or other licensed practitioner</span><span style='font-size:12.0pt;font-family: "Times New Roman",serif'> through a written prescription and provided by a physical therapist</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> licensed under SDCL chapter <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=36-10">36-10</A> or by a physical therapist assistant certified under SDCL chapter 36-10</span><span style='font-size:12.0pt; font-family:"Times New Roman",serif'> are covered services under this article.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Any service provided by a physical therapist assistant shall be billed by the </span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>s</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>upervising</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> </span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>physical therapist.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>Source:</b> 7 SDR 109, effective May 31, 1981; 16 SDR 234, effective July 2, 1990; 19&nbsp;SDR&nbsp;165, effective May 3, 1993; 34 SDR 68, effective September 12, 2007; 44 SDR 94, effective December 4, 2017.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&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.</A></span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&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</A></span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>(1)(2)</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>Cross-Reference:</b> School districts, ch 67:16:37.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> </div> </body> </html> <br /><hr><br /><html xmlns:v="urn:schemas-microsoft-com:vml" xmlns:o="urn:schemas-microsoft-com:office:office" xmlns:w="urn:schemas-microsoft-com:office:word" xmlns="http://www.w3.org/TR/REC-html40"> <head> <title>Rule 67:16:02:05.02 Repealed.</title> <META NAME="Keywords" Content="Administrative Rules 67:16:02:05.02"> <META NAME="Description" Content="Administrative Rules 67:16:02:05.02 Repealed."> <meta http-equiv=Content-Type content="text/html; charset=windows-1252"> <meta name=ProgId content=Word.Document> <meta name=Generator content="Microsoft Word 10"> <meta name=Originator content="Microsoft Word 10"> <link rel=File-List href="6716020000502d_files/filelist.xml"> <!--[if gte mso 9]><xml> <o:DocumentProperties> <o:Author>lrpr14533</o:Author> <o:LastAuthor>lrpr14296</o:LastAuthor> <o:Revision>2</o:Revision> <o:TotalTime>1</o:TotalTime> <o:Created>2010-09-27T15:00:00Z</o:Created> <o:LastSaved>2010-09-27T15:00:00Z</o:LastSaved> <o:Pages>1</o:Pages> <o:Words>38</o:Words> <o:Characters>222</o:Characters> <o:Company>State of South Dakota</o:Company> <o:Lines>1</o:Lines> <o:Paragraphs>1</o:Paragraphs> <o:CharactersWithSpaces>259</o:CharactersWithSpaces> <o:Version>10.6858</o:Version> 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2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><span style='mso-tab-count:1'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span><b style='mso-bidi-font-weight:normal'>67:16:02:05.02.&nbsp;&nbsp;Breast reductions covered -- Prior authorization required.</b> Repealed.<o:p></o:p></span></p> <p class=MsoNormal style='text-align:justify;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='text-align:justify;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><span style='mso-tab-count:1'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span><b style='mso-bidi-font-weight:normal'>Source:</b> 16 SDR 64, effective October 8, 1989; 16 SDR 234, effective July 2, 1990; 28 SDR 166, effective June 12, 2002; repealed, 37 SDR 53, effective September 23, 2010.<o:p></o:p></span></p> <p class=MsoNormal style='text-align:justify;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p> </div> </body> </html> <br /><hr><br /><html> <head> <title>Rule 67:16:02:05.03 Repealed.</title> <META NAME="Keywords" Content="Administrative Rules 67:16:02:05.03"> <META NAME="Description" Content="Administrative Rules 67:16:02:05.03 Repealed."> <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>67:16:02:05.03.&nbsp;&nbsp;Clozaril therapy -- Limits.</b>Repealed.</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> 18 SDR 50, effective September 15, 1991; repealed, 31 SDR 214, effective July 6, 2005.</font></p> <p><font size=3 face="Times New Roman">&nbsp;</font></p> </div> </body> </html> <br /><hr><br /><html xmlns:v="urn:schemas-microsoft-com:vml" xmlns:o="urn:schemas-microsoft-com:office:office" xmlns:w="urn:schemas-microsoft-com:office:word" xmlns="http://www.w3.org/TR/REC-html40"> <head> <title>Rule 67:16:02:05.04 Repealed.</title> <META NAME="Keywords" Content="Administrative Rules 67:16:02:05.04"> <META NAME="Description" Content="Administrative Rules 67:16:02:05.04 Repealed."> <meta http-equiv=Content-Type content="text/html; charset=windows-1252"> <meta name=ProgId content=Word.Document> <meta name=Generator content="Microsoft Word 10"> <meta name=Originator content="Microsoft Word 10"> <link rel=File-List href="6716020000504d_files/filelist.xml"> <!--[if gte mso 9]><xml> <o:DocumentProperties> <o:Author>lrpr14296</o:Author> <o:LastAuthor>lrpr14296</o:LastAuthor> <o:Revision>2</o:Revision> <o:TotalTime>5</o:TotalTime> <o:Created>2006-03-01T20:51:00Z</o:Created> <o:LastSaved>2006-03-01T20:51:00Z</o:LastSaved> <o:Pages>1</o:Pages> <o:Words>31</o:Words> <o:Characters>182</o:Characters> <o:Company>State of South Dakota</o:Company> <o:Lines>1</o:Lines> <o:Paragraphs>1</o:Paragraphs> <o:CharactersWithSpaces>212</o:CharactersWithSpaces> <o:Version>10.4219</o:Version> </o:DocumentProperties> <o:OfficeDocumentSettings> <o:DoNotRelyOnCSS/> </o:OfficeDocumentSettings> </xml><![endif]--><!--[if gte mso 9]><xml> <w:WordDocument> <w:GrammarState>Clean</w:GrammarState> <w:DisplayHorizontalDrawingGridEvery>0</w:DisplayHorizontalDrawingGridEvery> <w:DisplayVerticalDrawingGridEvery>0</w:DisplayVerticalDrawingGridEvery> <w:UseMarginsForDrawingGridOrigin/> <w:Compatibility> <w:FootnoteLayoutLikeWW8/> <w:ShapeLayoutLikeWW8/> <w:AlignTablesRowByRow/> <w:ForgetLastTabAlignment/> <w:LayoutRawTableWidth/> <w:LayoutTableRowsApart/> <w:UseWord97LineBreakingRules/> </w:Compatibility> <w:BrowserLevel>MicrosoftInternetExplorer4</w:BrowserLevel> </w:WordDocument> </xml><![endif]--> <style> <!-- /* Font Definitions */ @font-face {font-family:Times; panose-1:2 2 6 3 5 4 5 2 3 4; mso-font-charset:0; mso-generic-font-family:roman; mso-font-pitch:variable; mso-font-signature:536902279 -2147483648 8 0 511 0;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-parent:""; margin:0in; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:Times; mso-fareast-font-family:"Times New Roman"; mso-bidi-font-family:"Times New Roman";} span.GramE {mso-style-name:""; mso-gram-e:yes;} @page Section1 {size:8.5in 11.0in; margin:1.0in 1.25in 1.0in 1.25in; mso-header-margin:.5in; mso-footer-margin:.5in; mso-paper-source:0;} div.Section1 {page:Section1;} --> </style> <!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman";} </style> <![endif]--><!--[if gte mso 9]><xml> <o:shapedefaults v:ext="edit" spidmax="1026"/> </xml><![endif]--><!--[if gte mso 9]><xml> <o:shapelayout v:ext="edit"> <o:idmap v:ext="edit" data="1"/> </o:shapelayout></xml><![endif]--> </head> <body lang=EN-US style='tab-interval:.5in'> <div class=Section1> <p class=MsoNormal style='text-align:justify;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><span style='mso-tab-count:1'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span><b style='mso-bidi-font-weight:normal'><span style='font-weight:bold;mso-bidi-font-weight: normal'>67:16:02:05.04.<span class=GramE>&nbsp;&nbsp;Documentation</span> required before authorization given.</span></b> <span class=GramE>Repealed.</span><o:p></o:p></span></font></p> <p class=MsoNormal style='text-align:justify;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> <p class=MsoNormal style='text-align:justify;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><span style='mso-tab-count:1'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span><b style='mso-bidi-font-weight:normal'><span style='font-weight:bold;mso-bidi-font-weight: normal'>Source:</span></b> 18 SDR 50, effective September 15, 1991; 26 SDR 168, effective July 1, 2000; repealed, 31 SDR 214, effective July 6, 2005.<o:p></o:p></span></font></p> <p class=MsoNormal style='text-align:justify;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;mso-bidi-font-size: 10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></font></p> </div> </body> </html> <br /><hr><br /><html> <head> <title>Rule 67:16:02:05.05 Repealed.</title> <META NAME="Keywords" Content="Administrative Rules 67:16:02:05.05"> <META NAME="Description" Content="Administrative Rules 67:16:02:05.05 Repealed."> <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>67:16:02:05.05.&nbsp;&nbsp;Requirements for monitoring clozaril therapy.</b>Repealed.</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> 18 SDR 50, effective September 15, 1991; repealed, 31 SDR 214, effective July 6, 2005.</font></p> <p><font size=3 face="Times New Roman">&nbsp;</font></p> </div> </body> </html> <br /><hr><br /><html> <head> <title>Rule 67:16:02:05.06 Repealed.</title> <META NAME="Keywords" Content="Administrative Rules 67:16:02:05.06"> <META NAME="Description" Content="Administrative Rules 67:16:02:05.06 Repealed."> <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>67:16:02:05.06.&nbsp;&nbsp;Requirements when clozaril therapy discontinued or suspended.</b>Repealed.</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> 18 SDR 50, effective September 15, 1991; repealed, 31 SDR 214, effective July 6, 2005.</font></p> <p><font size=3 face="Times New Roman">&nbsp;</font></p> </div> </body> </html> <br /><hr><br /><html> <head> <title>Rule 67:16:02:05.07 Repealed.</title> <META NAME="Keywords" Content="Administrative Rules 67:16:02:05.07"> <META NAME="Description" Content="Administrative Rules 67:16:02:05.07 Repealed."> <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>67:16:02:05.07.&nbsp;&nbsp;Requirements for augmentative communication device.</b>&nbsp; Repealed</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> 19 SDR 26, effective August 23, 1992; repealed, 24 SDR 11, effective August 4, 1997.</font></p> <p><font size=3 face="Times New Roman">&nbsp;</font></p> </div> </body> </html> <br /><hr><br /><html> <head> <title>Rule 67:16:02:05.08 Repealed.</title> <META NAME="Keywords" Content="Administrative Rules 67:16:02:05.08"> <META NAME="Description" Content="Administrative Rules 67:16:02:05.08 Repealed."> <meta http-equiv=Content-Type content="text/html; charset=windows-1252"> <meta name=Generator content="Microsoft Word 14 (filtered)"> <style> <!-- /* Font Definitions */ @font-face {font-family:Calibri; panose-1:2 15 5 2 2 2 4 3 2 4;} @font-face {font-family:Times; panose-1:0 0 0 0 0 0 0 0 0 0;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {margin:0in; margin-bottom:.0001pt; font-size:10.0pt; font-family:Times;} @page WordSection1 {size:8.5in 11.0in; margin:1.0in 1.0in 1.0in 1.0in;} div.WordSection1 {page:WordSection1;} --> </style> </head> <body lang=EN-US> <div class=WordSection1> <p class=MsoNormal style='text-align:justify'><a name="_GoBack"></a><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>67:16:02:05.08.&nbsp;&nbsp;Requirements for hyperbaric oxygen therapy.</b> Repealed.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman","serif"'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman","serif"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>Source:</b> 20 SDR 144, effective March 10, 1994; 34 SDR 68, effective September 12, 2007; 42 SDR 51, effective October 13, 2015.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman","serif"'>&nbsp;</span></p> </div> </body> </html> <br /><hr><br /><html> <head> <title>Rule 67:16:02:05.09 Repealed.</title> <META NAME="Keywords" Content="Administrative Rules 67:16:02:05.09"> <META NAME="Description" Content="Administrative Rules 67:16:02:05.09 Repealed."> <meta http-equiv=Content-Type content="text/html; charset=windows-1252"> <meta name=Generator content="Microsoft Word 14 (filtered)"> <style> <!-- /* Font Definitions */ @font-face {font-family:Calibri; panose-1:2 15 5 2 2 2 4 3 2 4;} @font-face {font-family:Times; panose-1:0 0 0 0 0 0 0 0 0 0;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {margin:0in; margin-bottom:.0001pt; font-size:10.0pt; font-family:Times;} @page WordSection1 {size:8.5in 11.0in; margin:1.0in 1.0in 1.0in 1.0in;} div.WordSection1 {page:WordSection1;} --> </style> </head> <body lang=EN-US> <div class=WordSection1> <p class=MsoNormal style='text-align:justify'><a name="_GoBack"></a><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>67:16:02:05.09.&nbsp;&nbsp;Prior authorization for hyperbaric oxygen therapy.</b> Repealed.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman","serif"'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman","serif"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>Source:</b> 20 SDR 144, effective March 10, 1994; 42 SDR 51, effective October 13, 2015.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman","serif"'>&nbsp;</span></p> </div> </body> </html> <br /><hr><br /><html> <head> <title>Rule 67:16:02:05.10 Repealed.</title> <META NAME="Keywords" Content="Administrative Rules 67:16:02:05.10"> <META NAME="Description" Content="Administrative Rules 67:16:02:05.10 Repealed."> <meta http-equiv=Content-Type content="text/html; charset=windows-1252"> <meta name=Generator content="Microsoft Word 14 (filtered)"> <style> <!-- /* Font Definitions */ @font-face {font-family:Calibri; panose-1:2 15 5 2 2 2 4 3 2 4;} @font-face {font-family:Times; panose-1:0 0 0 0 0 0 0 0 0 0;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {margin:0in; margin-bottom:.0001pt; font-size:10.0pt; font-family:Times;} @page WordSection1 {size:8.5in 11.0in; margin:1.0in 1.0in 1.0in 1.0in;} div.WordSection1 {page:WordSection1;} --> </style> </head> <body lang=EN-US> <div class=WordSection1> <p class=MsoNormal style='text-align:justify'><a name="_GoBack"></a><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>67:16:02:05.10.&nbsp;&nbsp;Breast reconstruction.</b> Repealed.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman","serif"'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman","serif"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>Source:</b> 28 SDR 166, effective June 12, 2002; 42 SDR 51, effective October 13, 2015.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman","serif"'>&nbsp;</span></p> </div> </body> </html> <br /><hr><br /><html xmlns:v="urn:schemas-microsoft-com:vml" xmlns:o="urn:schemas-microsoft-com:office:office" xmlns:w="urn:schemas-microsoft-com:office:word" xmlns="http://www.w3.org/TR/REC-html40"> <head> <title>Rule 67:16:02:05.11 Repealed.</title> <META NAME="Keywords" Content="Administrative Rules 67:16:02:05.11"> <META NAME="Description" Content="Administrative Rules 67:16:02:05.11 Repealed."> <meta http-equiv=Content-Type content="text/html; charset=windows-1252"> <meta name=ProgId content=Word.Document> <meta name=Generator content="Microsoft Word 10"> <meta name=Originator content="Microsoft Word 10"> <link rel=File-List href="6716020000511d_files/filelist.xml"> <!--[if gte mso 9]><xml> <o:DocumentProperties> <o:Author>lrpr14533</o:Author> <o:LastAuthor>lrpr14296</o:LastAuthor> <o:Revision>2</o:Revision> <o:TotalTime>1</o:TotalTime> <o:Created>2010-09-27T15:00:00Z</o:Created> 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mso-font-pitch:variable; mso-font-signature:-1610611985 1073750139 0 0 159 0;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-parent:""; margin:0in; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:Times; mso-fareast-font-family:"Times New Roman"; mso-bidi-font-family:"Times New Roman";} @page Section1 {size:8.5in 11.0in; margin:1.0in 1.0in 1.0in 1.0in; mso-header-margin:.5in; mso-footer-margin:.5in; mso-paper-source:0;} div.Section1 {page:Section1;} --> </style> <!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:Calibri;} </style> <![endif]--><!--[if gte mso 9]><xml> <o:shapedefaults v:ext="edit" spidmax="2050"/> </xml><![endif]--><!--[if gte mso 9]><xml> <o:shapelayout v:ext="edit"> <o:idmap v:ext="edit" data="1"/> </o:shapelayout></xml><![endif]--> </head> <body lang=EN-US style='tab-interval:.5in'> <div class=Section1> <p class=MsoNormal style='text-align:justify;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><span style='mso-tab-count:1'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span><b style='mso-bidi-font-weight:normal'>67:16:02:05.11.&nbsp;&nbsp;Noninvasive bone-growth stimulation.</b> Repealed.<o:p></o:p></span></p> <p class=MsoNormal style='text-align:justify;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='text-align:justify;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><span style='mso-tab-count:1'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span><b style='mso-bidi-font-weight:normal'>Source:</b> 28 SDR 166, effective June 12, 2002; 34 SDR 68, effective September 12, 2007; repealed, 37 SDR 53, effective September 23, 2010.<o:p></o:p></span></p> <p class=MsoNormal style='text-align:justify;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p> </div> </body> </html> <br /><hr><br /><html> <head> <title>Rule 67:16:02:05.12 Repealed.</title> <META NAME="Keywords" Content="Administrative Rules 67:16:02:05.12"> <META NAME="Description" Content="Administrative Rules 67:16:02:05.12 Repealed."> <meta http-equiv=Content-Type content="text/html; charset=windows-1252"> <meta name=Generator content="Microsoft Word 14 (filtered)"> <style> <!-- /* Font Definitions */ @font-face {font-family:Calibri; panose-1:2 15 5 2 2 2 4 3 2 4;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {margin:0in; margin-bottom:.0001pt; text-align:justify; font-size:12.0pt; font-family:"Times New Roman","serif";} @page WordSection1 {size:8.5in 11.0in; margin:1.0in 1.0in 1.0in 1.0in;} div.WordSection1 {page:WordSection1;} --> </style> </head> <body lang=EN-US> <div class=WordSection1> <p class=MsoNormal>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>67:16:02:05.12.&nbsp;&nbsp;Cochlear implant -- Prior authorization required.</b> Repealed.</p> <p class=MsoNormal>&nbsp;</p> <p class=MsoNormal>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>Source:</b> 28 SDR 178, effective July 3, 2002; repealed, 40 SDR 122, effective January 7, 2014.</p> <p class=MsoNormal>&nbsp;</p> </div> </body> </html> <br /><hr><br /><html> <head> <title>Rule 67:16:02:05.13 Repealed.</title> <META NAME="Keywords" Content="Administrative Rules 67:16:02:05.13"> <META NAME="Description" Content="Administrative Rules 67:16:02:05.13 Repealed."> <meta http-equiv=Content-Type content="text/html; charset=windows-1252"> <meta name=Generator content="Microsoft Word 14 (filtered)"> <style> <!-- /* Font Definitions */ @font-face {font-family:Calibri; panose-1:2 15 5 2 2 2 4 3 2 4;} @font-face {font-family:Times; panose-1:0 0 0 0 0 0 0 0 0 0;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {margin:0in; margin-bottom:.0001pt; font-size:10.0pt; font-family:Times;} @page WordSection1 {size:8.5in 11.0in; margin:1.0in 1.0in 1.0in 1.0in;} div.WordSection1 {page:WordSection1;} --> </style> </head> <body lang=EN-US> <div class=WordSection1> <p class=MsoNormal style='text-align:justify'><a name="_GoBack"></a><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>67:16:02:05.13.&nbsp;&nbsp;Hyperbaric oxygen therapy for individual with diabetes.</b> Repealed.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman","serif"'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman","serif"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>Source:</b> 34 SDR 68, effective September 12, 2007; 42 SDR 51, effective October 13, 2015.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman","serif"'>&nbsp;</span></p> </div> </body> </html> <br /><hr><br /><html> <head> <title>Rule 67:16:02:05.14 Repealed.</title> <META NAME="Keywords" Content="Administrative Rules 67:16:02:05.14"> <META NAME="Description" Content="Administrative Rules 67:16:02:05.14 Repealed."> <meta http-equiv=Content-Type content="text/html; charset=windows-1252"> <meta name=Generator content="Microsoft Word 14 (filtered)"> <style> <!-- /* Font Definitions */ @font-face {font-family:Calibri; panose-1:2 15 5 2 2 2 4 3 2 4;} @font-face {font-family:Times; panose-1:0 0 0 0 0 0 0 0 0 0;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {margin:0in; margin-bottom:.0001pt; font-size:10.0pt; font-family:Times;} @page WordSection1 {size:8.5in 11.0in; margin:1.0in 1.0in 1.0in 1.0in;} div.WordSection1 {page:WordSection1;} --> </style> </head> <body lang=EN-US> <div class=WordSection1> <p class=MsoNormal style='text-align:justify'><a name="_GoBack"></a><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>67:16:02:05.14.&nbsp;&nbsp;Hyperbaric oxygen therapy -- Individual with diabetes -- Course of standard wound care.</b> Repealed.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman","serif"'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman","serif"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>Source:</b> 34 SDR 68, effective September 12, 2007; 42 SDR 51, effective October 13, 2015.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman","serif"'>&nbsp;</span></p> </div> </body> </html> <br /><hr><br /><html> <head> <title>Rule 67:16:02:05.15 Occupational therapy.</title> <META NAME="Keywords" Content="Administrative Rules 67:16:02:05.15"> <META NAME="Description" Content="Administrative Rules 67:16:02:05.15 Occupational therapy."> <meta http-equiv=Content-Type content="text/html; charset=windows-1252"> <meta name=Generator content="Microsoft Word 15 (filtered)"> <style> <!-- /* Font Definitions */ @font-face {font-family:"Cambria Math"; panose-1:2 4 5 3 5 4 6 3 2 4;} @font-face {font-family:Times; panose-1:2 2 6 3 5 4 5 2 3 4;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {margin:0in; margin-bottom:.0001pt; font-size:10.0pt; font-family:"Times",serif; color:black;} a:link, span.MsoHyperlink {color:blue; text-decoration:underline;} a:visited, span.MsoHyperlinkFollowed {color:#954F72; text-decoration:underline;} .MsoChpDefault {font-size:10.0pt; color:black;} @page WordSection1 {size:8.5in 11.0in; margin:1.0in 1.25in 1.0in 1.25in;} div.WordSection1 {page:WordSection1;} --> </style> </head> <body lang=EN-US link=blue vlink="#954F72"> <div class=WordSection1> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>67:16:02:05.15.&nbsp;&nbsp;Occupational therapy.</b> Occupational therapy services are covered services if ordered by a physician</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> or other licensed practitioner</span><span style='font-size:12.0pt;font-family: "Times New Roman",serif'> through a written prescription and provided by a</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>n</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> </span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>occupational</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> therapist</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> licensed under SDCL chapter <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=36-31">36-31</A> or by an occupational therapy assistant licensed under SDCL chapter 36-31.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Any service provided by an occupational therapy assistant shall be billed by the supervising occupational therapist</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>Source:</b> 34 SDR 68, effective September 12, 2007; 44 SDR 94, effective December 4, 2017.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&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</A></span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>(1)(2)</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&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</A></span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>(1)(2)</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>Cross-Reference:</b> School districts, ch 67:16:37.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> </div> </body> </html> <br /><hr><br /><html xmlns="http://www.w3.org/1999/xhtml"><head><meta charset="UTF-8" /><title></title><meta name="Generator" content="PowerTools for Open XML" /><style>p.s7c3f96fb-9888-4191-83d9-0b10c76e86b2P0 { 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.s7c3f96fb-9888-4191-83d9-0b10c76e86b2C0 { color: black; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.s7c3f96fb-9888-4191-83d9-0b10c76e86b2C0-000000 { color: #0000FF; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.s7c3f96fb-9888-4191-83d9-0b10c76e86b2C0-000001 { color: black; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.s7c3f96fb-9888-4191-83d9-0b10c76e86b2C0-000002 { color: #0000FF; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.s7c3f96fb-9888-4191-83d9-0b10c76e86b2000003 { color: black; background: white; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } </style></head><body><div><p dir="ltr" class="s7c3f96fb-9888-4191-83d9-0b10c76e86b2P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s7c3f96fb-9888-4191-83d9-0b10c76e86b2C0">    </span><a href="https://sdlegislature.gov/Rules?Rule=67:16:02:06"><span style="white-space: pre-wrap;" class="s7c3f96fb-9888-4191-83d9-0b10c76e86b2C0-000000">67:16:02:06</span></a><span style="white-space: pre-wrap;" class="s7c3f96fb-9888-4191-83d9-0b10c76e86b2C0-000001">.  Health services not covered.</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s7c3f96fb-9888-4191-83d9-0b10c76e86b2C0"> In addition to the services not specifically listed in § </span><a href="https://sdlegislature.gov/Rules?Rule=67:16:02:05"><span style="white-space: pre-wrap;" class="s7c3f96fb-9888-4191-83d9-0b10c76e86b2C0-000002">67:16:02:05</span></a><span style="white-space: pre-wrap;" class="s7c3f96fb-9888-4191-83d9-0b10c76e86b2C0">, the following health services and items are not covered under the medical assistance program:</span></p><p dir="ltr" class="s7c3f96fb-9888-4191-83d9-0b10c76e86b2P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s7c3f96fb-9888-4191-83d9-0b10c76e86b2000003"> </span></p><p dir="ltr" class="s7c3f96fb-9888-4191-83d9-0b10c76e86b2P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s7c3f96fb-9888-4191-83d9-0b10c76e86b2C0">    (1)  Medical equipment for a resident in a nursing facility</span><span style="white-space: pre-wrap;" class="s7c3f96fb-9888-4191-83d9-0b10c76e86b2C0">,</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s7c3f96fb-9888-4191-83d9-0b10c76e86b2C0"> an intermediate care facility for individuals with intellectual disabilities</span><span style="white-space: pre-wrap;" class="s7c3f96fb-9888-4191-83d9-0b10c76e86b2C0">, or an institution for individuals with a mental disease</span><span style="white-space: pre-wrap;" class="s7c3f96fb-9888-4191-83d9-0b10c76e86b2C0">;</span></p><p dir="ltr" class="s7c3f96fb-9888-4191-83d9-0b10c76e86b2P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s7c3f96fb-9888-4191-83d9-0b10c76e86b2000003"> </span></p><p dir="ltr" class="s7c3f96fb-9888-4191-83d9-0b10c76e86b2P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s7c3f96fb-9888-4191-83d9-0b10c76e86b2C0">    (2)  Self-help devices, exercise equipment, protective outerwear, and personal comfort or environmental control equipment, including air conditioners, humidifiers, dehumidifiers, heaters, and furnaces;</span></p><p dir="ltr" class="s7c3f96fb-9888-4191-83d9-0b10c76e86b2P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s7c3f96fb-9888-4191-83d9-0b10c76e86b2000003"> </span></p><p dir="ltr" class="s7c3f96fb-9888-4191-83d9-0b10c76e86b2P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s7c3f96fb-9888-4191-83d9-0b10c76e86b2C0">    (3)  Any weight loss program or activity;</span></p><p dir="ltr" class="s7c3f96fb-9888-4191-83d9-0b10c76e86b2P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s7c3f96fb-9888-4191-83d9-0b10c76e86b2000003"> </span></p><p dir="ltr" class="s7c3f96fb-9888-4191-83d9-0b10c76e86b2P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s7c3f96fb-9888-4191-83d9-0b10c76e86b2C0">    (4)  Agents to promote fertility;</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s7c3f96fb-9888-4191-83d9-0b10c76e86b2C0"> and</span></p><p dir="ltr" class="s7c3f96fb-9888-4191-83d9-0b10c76e86b2P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s7c3f96fb-9888-4191-83d9-0b10c76e86b2000003"> </span></p><p dir="ltr" class="s7c3f96fb-9888-4191-83d9-0b10c76e86b2P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s7c3f96fb-9888-4191-83d9-0b10c76e86b2C0">    (5)  Procedures to reverse a previous sterilization</span><span style="white-space: pre-wrap;" class="s7c3f96fb-9888-4191-83d9-0b10c76e86b2C0">.</span></p><p dir="ltr" class="s7c3f96fb-9888-4191-83d9-0b10c76e86b2P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s7c3f96fb-9888-4191-83d9-0b10c76e86b2000003"> </span></p><p dir="ltr" class="s7c3f96fb-9888-4191-83d9-0b10c76e86b2P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s7c3f96fb-9888-4191-83d9-0b10c76e86b2C0">    </span><span style="white-space: pre-wrap;" class="s7c3f96fb-9888-4191-83d9-0b10c76e86b2C0-000001">Source:</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s7c3f96fb-9888-4191-83d9-0b10c76e86b2C0"> SL 1975, ch 16, § 1; 7 SDR 66, 7 SDR 89, effective July 1, 1981; 9 SDR 164, effective June 30, 1983; 11 SDR 86, effective December 30, 1984; 16 SDR 234, effective July 2, 1990; 17 SDR 200, effective July 1, 1991; 19 SDR 26, effective August 23, 1992; 19 SDR 165, effective May 3, 1993; 20 SDR 144, effective March 10, 1994; 37 SDR 53, effective September 23, 2010; 40 SDR 122, effective January 8, 2014</span><span style="white-space: pre-wrap;" class="s7c3f96fb-9888-4191-83d9-0b10c76e86b2C0">; 50 SDR 63, effective November 27, 2023</span><span style="white-space: pre-wrap;" class="s7c3f96fb-9888-4191-83d9-0b10c76e86b2C0">.</span></p><p dir="ltr" class="s7c3f96fb-9888-4191-83d9-0b10c76e86b2P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s7c3f96fb-9888-4191-83d9-0b10c76e86b2C0">    </span><span style="white-space: pre-wrap;" class="s7c3f96fb-9888-4191-83d9-0b10c76e86b2C0-000001">General Authority:</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s7c3f96fb-9888-4191-83d9-0b10c76e86b2C0"> SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=28-6-1"><span style="white-space: pre-wrap;" class="s7c3f96fb-9888-4191-83d9-0b10c76e86b2C0-000002">28-6-1</span></a><span style="white-space: pre-wrap;" class="s7c3f96fb-9888-4191-83d9-0b10c76e86b2C0">.</span></p><p dir="ltr" class="s7c3f96fb-9888-4191-83d9-0b10c76e86b2P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s7c3f96fb-9888-4191-83d9-0b10c76e86b2C0">    </span><span style="white-space: pre-wrap;" class="s7c3f96fb-9888-4191-83d9-0b10c76e86b2C0-000001">Law Implemented:</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s7c3f96fb-9888-4191-83d9-0b10c76e86b2C0"> SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=28-6-1"><span style="white-space: pre-wrap;" class="s7c3f96fb-9888-4191-83d9-0b10c76e86b2C0-000002">28-6-1</span></a><span style="white-space: pre-wrap;" class="s7c3f96fb-9888-4191-83d9-0b10c76e86b2C0">.</span></p><p dir="ltr" class="s7c3f96fb-9888-4191-83d9-0b10c76e86b2P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s7c3f96fb-9888-4191-83d9-0b10c76e86b2000003"> </span></p><p dir="ltr" class="s7c3f96fb-9888-4191-83d9-0b10c76e86b2P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s7c3f96fb-9888-4191-83d9-0b10c76e86b2C0">    </span><span style="white-space: pre-wrap;" class="s7c3f96fb-9888-4191-83d9-0b10c76e86b2C0-000001">Cross-References:</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s7c3f96fb-9888-4191-83d9-0b10c76e86b2C0"> </span></p><p dir="ltr" class="s7c3f96fb-9888-4191-83d9-0b10c76e86b2P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s7c3f96fb-9888-4191-83d9-0b10c76e86b2C0">    </span><span style="white-space: pre-wrap;" class="s7c3f96fb-9888-4191-83d9-0b10c76e86b2C0">Medical equipment, ch</span><span style="white-space: pre-wrap;" class="s7c3f96fb-9888-4191-83d9-0b10c76e86b2C0">apter</span><span style="white-space: pre-wrap;" xml:space="preserve" class="s7c3f96fb-9888-4191-83d9-0b10c76e86b2C0"> </span><a href="https://sdlegislature.gov/Rules?Rule=67:16:29"><span style="white-space: pre-wrap;" class="s7c3f96fb-9888-4191-83d9-0b10c76e86b2C0-000002">67:16:29</span></a><span style="white-space: pre-wrap;" class="s7c3f96fb-9888-4191-83d9-0b10c76e86b2C0">.</span></p><p dir="ltr" class="s7c3f96fb-9888-4191-83d9-0b10c76e86b2P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s7c3f96fb-9888-4191-83d9-0b10c76e86b2C0">    </span><span style="white-space: pre-wrap;" xml:space="preserve" class="s7c3f96fb-9888-4191-83d9-0b10c76e86b2C0">Services not covered, § </span><a href="https://sdlegislature.gov/Rules?Rule=67:16:01:08"><span style="white-space: pre-wrap;" class="s7c3f96fb-9888-4191-83d9-0b10c76e86b2C0-000002">67:16:01:08</span></a><span style="white-space: pre-wrap;" class="s7c3f96fb-9888-4191-83d9-0b10c76e86b2C0">.</span></p><p dir="ltr" class="s7c3f96fb-9888-4191-83d9-0b10c76e86b2P0"><span style="white-space: pre-wrap;" xml:space="preserve" class="s7c3f96fb-9888-4191-83d9-0b10c76e86b2000003"> </span></p></div></body></html><br /><hr><br /><html> <head> <title>Rule 67:16:02:07 Utilization review for physician, laboratory, and X-ray services.</title> <META NAME="Keywords" Content="Administrative Rules 67:16:02:07"> <META NAME="Description" Content="Administrative Rules 67:16:02:07 Utilization review for physician, laboratory, and X-ray 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>67:16:02:07.&nbsp;&nbsp;Utilization review for physician, laboratory, and X-ray services.</b> Utilization review for physician, laboratory, and X-ray services may be provided on three levels:</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; (1)&nbsp;&nbsp;Computerized claims processing;</font></p> <p><font size=3 face="Times New Roman">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (2)&nbsp;&nbsp;Postpayment reviews; and</font></p> <p><font size=3 face="Times New Roman">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (3)&nbsp;&nbsp;Peer review.</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> SL 1975, ch 16, §&nbsp;1; 7 SDR 66, 7 SDR 89, effective July 1, 1981; 16 SDR 234, effective July 2, 1990.</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.</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.</A></font></p> <p><font size=3 face="Times New Roman">&nbsp;</font></p> </div> </body> </html> <br /><hr><br /><html> <head> <title>Rule 67:16:02:08 Repealed.</title> <META NAME="Keywords" Content="Administrative Rules 67:16:02:08"> <META NAME="Description" Content="Administrative Rules 67:16:02:08 Repealed."> <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>67:16:02:08.&nbsp;&nbsp;Utilization review for transportation services.</b> Repealed.</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> SL 1975, ch 16, §&nbsp;1; 2 SDR 88, effective July 1, 1976; repealed, 7 SDR 23, effective September 18, 1980.</font></p> <p><font size=3 face="Times New Roman">&nbsp;</font></p> </div> </body> </html> <br /><hr><br /><html> <head> <title>Rule 67:16:02:09 Sterilization.</title> <META NAME="Keywords" Content="Administrative Rules 67:16:02:09"> <META NAME="Description" Content="Administrative Rules 67:16:02:09 Sterilization."> <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>67:16:02:09.&nbsp;&nbsp;Sterilization.</b> Payment for sterilization is limited to those procedures performed on a recipient who meets the following criteria:</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; (1)&nbsp;&nbsp;Is at least 21 years old;</font></p> <p><font size=3 face="Times New Roman">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (2)&nbsp;&nbsp;Is a legally competent individual;</font></p> <p><font size=3 face="Times New Roman">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (3)&nbsp;&nbsp;Has signed an informed consent form after the recipient's 21st birthday; and</font></p> <p><font size=3 face="Times New Roman">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (4)&nbsp;&nbsp;At least 30 days but not more than 180 days have passed between the date the informed consent form was signed and the date of the sterilization.</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; In the case of a premature delivery, subdivision (4) of this section may be waived if the informed consent form was signed at least 30 days before the expected delivery date and if at least 72 hours have passed between the time the informed consent form was signed and the time of the delivery.</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; In the case of emergency abdominal surgery, subdivision (4) of this section may be waived if the informed consent form was signed at least 72 hours before the emergency surgery was performed.</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> SL 1975, ch 16, §&nbsp;1; 2 SDR 88, effective July 1, 1976; 5 SDR 109, effective July 1, 1979; 7 SDR 66, 7 SDR 89, effective July 1, 1981; 14 SDR 87, effective December 27, 1987.</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.</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.</A></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>Cross-Reference:</b> Sterilization of a mentally competent individual aged 21 or older, 42 C.F.R. §&nbsp;441.253.</font></p> <p><font size=3 face="Times New Roman">&nbsp;</font></p> </div> </body> </html> <br /><hr><br /><html> <head> <title>Rule 67:16:02:10 Refractions and eyeglasses.</title> <META NAME="Keywords" Content="Administrative Rules 67:16:02:10"> <META NAME="Description" Content="Administrative Rules 67:16:02:10 Refractions and eyeglasses."> <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>67:16:02:10.&nbsp;&nbsp;Refractions and eyeglasses.</b> Payable physician services relating to refractions and the provision of eyeglasses are subject to the limits established in chapter 67:16:08.</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> SL 1975, ch 16, §&nbsp;1; 2 SDR 88, effective July 1, 1976; 3 SDR 26, effective October 6, 1976; 7 SDR 66, 7 SDR 89, effective July 1, 1981; 14 SDR 46, effective September 28, 1987; 16 SDR 64, effective October 8, 1989; 17 SDR 200, effective July 1, 1991.</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.</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.</A></font></p> <p><font size=3 face="Times New Roman">&nbsp;</font></p> </div> </body> </html> <br /><hr><br /><html> <head> <title>Rule 67:16:02:11 Repealed.</title> <META NAME="Keywords" Content="Administrative Rules 67:16:02:11"> <META NAME="Description" Content="Administrative Rules 67:16:02:11 Repealed."> <meta http-equiv=Content-Type content="text/html; charset=windows-1252"> <meta name=Generator content="Microsoft Word 14 (filtered)"> <style> <!-- /* Font Definitions */ @font-face {font-family:Calibri; panose-1:2 15 5 2 2 2 4 3 2 4;} @font-face {font-family:Times; panose-1:0 0 0 0 0 0 0 0 0 0;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {margin:0in; margin-bottom:.0001pt; font-size:10.0pt; font-family:Times;} @page WordSection1 {size:8.5in 11.0in; margin:1.0in 1.0in 1.0in 1.0in;} div.WordSection1 {page:WordSection1;} --> </style> </head> <body lang=EN-US> <div class=WordSection1> <p class=MsoNormal style='text-align:justify'><a name="_GoBack"></a><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>67:16:02:11.&nbsp;&nbsp;Cost sharing.</b> Repealed.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman","serif"'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman","serif"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>Source:</b> 9 SDR 164, effective June 30, 1983; 10 SDR 79, effective February 1, 1984; 12 SDR 6, effective July 28, 1985; 31 SDR 191, effective June 8, 2005; 42 SDR 51, effective October 13, 2015.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman","serif"'>&nbsp;</span></p> </div> </body> </html> <br /><hr><br /><html> <head> <title>Rule 67:16:02:12 Transferred.</title> <META NAME="Keywords" Content="Administrative Rules 67:16:02:12"> <META NAME="Description" Content="Administrative Rules 67:16:02:12 Transferred."> <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>67:16:02:12.&nbsp;&nbsp;Transferred to §§&nbsp;67:16:29:02 and 67:16:29:05.</b></font></p> <p><font size=3 face="Times New Roman">&nbsp;</font></p> </div> </body> </html> <br /><hr><br /><html> <head> <title>Rule 67:16:02:13 Audiological and speech pathology services.</title> <META NAME="Keywords" Content="Administrative Rules 67:16:02:13"> <META NAME="Description" Content="Administrative Rules 67:16:02:13 Audiological and speech pathology services."> <meta http-equiv=Content-Type content="text/html; charset=windows-1252"> <meta name=Generator content="Microsoft Word 15 (filtered)"> <style> <!-- /* Font Definitions */ @font-face {font-family:"Cambria Math"; panose-1:2 4 5 3 5 4 6 3 2 4;} @font-face {font-family:Times; panose-1:2 2 6 3 5 4 5 2 3 4;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {margin:0in; margin-bottom:.0001pt; font-size:10.0pt; font-family:"Times",serif; color:black;} a:link, span.MsoHyperlink {color:blue; text-decoration:underline;} a:visited, span.MsoHyperlinkFollowed {color:#954F72; text-decoration:underline;} .MsoChpDefault {font-size:10.0pt; color:black;} @page WordSection1 {size:8.5in 11.0in; margin:1.0in 1.25in 1.0in 1.25in;} div.WordSection1 {page:WordSection1;} --> </style> </head> <body lang=EN-US link=blue vlink="#954F72"> <div class=WordSection1> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>67:16:02:13.&nbsp;&nbsp;Audiological and speech pathology services.</b> Payment may be made for audiological testing and speech</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>-language</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> pathology services if provided by a physician, a clinical audiologist</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> licensed under SDCL chapter <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=36-24">36-24</A></span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>, a speech</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>-language </span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>pathologist</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> licensed under SDCL chapter 36-37, or a speech-language pathology assistant licensed under SDCL chapter 36-37</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Covered services are limited to services provided by a physician or by the </span><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>clinical </span><span style='font-size: 12.0pt;font-family:"Times New Roman",serif'>audiologist</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>,</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> speech</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>-language</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> pathologist</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>, or speech-language pathology assistant</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> if the patient has a written referral from a physician</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> or other licensed practitioner</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> and the services are necessary to diagnose or treat a medical problem.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Any service provided by a speech-language pathology assistant shall be billed by the</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> </span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>supervising speech-language pathologist.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>Source:</b> 13 SDR 8, effective August 3, 1986; 16 SDR 234, effective July 2, 1990; 19 SDR 165, effective May 3, 1993; 23 SDR 38, effective September 26, 1996; 34 SDR 68, effective September 12, 2007; 44 SDR 94, effective December 4, 2017.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&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</A></span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>(1)(2)</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&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</A></span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>(1)(2)</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>Cross-Reference:</b> School districts, ch 67:16:37.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>NOTE:</b> Information relating to certification as a clinical audiologist or speech pathologist may be obtained from the American Speech and Hearing Association, 10801 Rockville Pike, Rockville, Maryland 20852.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> </div> </body> </html> <br /><hr><br /><html> <head> <title>Rule 67:16:02:14 Reimbursement for services provided by nurse midwife or nurse anesthetist.</title> <META NAME="Keywords" Content="Administrative Rules 67:16:02:14"> <META NAME="Description" Content="Administrative Rules 67:16:02:14 Reimbursement for services provided by nurse midwife or nurse anesthetist."> <meta http-equiv=Content-Type content="text/html; charset=windows-1252"> <meta name=Generator content="Microsoft Word 10 (filtered)"> <style> <!-- /* Font Definitions */ @font-face {font-family:Calibri; panose-1:2 15 5 2 2 2 4 3 2 4;} @font-face {font-family:Times; panose-1:2 2 6 3 5 4 5 2 3 4;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {margin:0in; margin-bottom:.0001pt; font-size:10.0pt; font-family:Times;} @page Section1 {size:8.5in 11.0in; margin:49.7pt 1.0in 49.7pt 63.35pt;} div.Section1 {page:Section1;} --> </style> </head> <body lang=EN-US> <div class=Section1> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;font-family:"Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b><span style='font-weight:bold'>67:16:02:14.&nbsp;&nbsp;Reimbursement for services provided by nurse midwife or nurse anesthetist.</span></b> Services provided by a nurse midwife or a nurse anesthetist are reimbursed at the rate for the same services provided by a physician.</span></font></p> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;font-family:"Times New Roman"'>&nbsp;</span></font></p> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;font-family:"Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b><span style='font-weight:bold'>Source:</span></b> 16 SDR 234, effective July 2, 1990; 37 SDR 36, effective June 28, 2012; 37 SDR 236, adopted June 28, 2011, effective July 1, 2012.</span></font></p> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;font-family:"Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b><span style='font-weight:bold'>General Authority:</span></b> SDCL <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=28-6-1">28-6-1.</A></span></font></p> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;font-family:"Times New Roman"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b><span style='font-weight:bold'>Law Implemented:</span></b> SDCL <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=28-6-1">28-6-1.</A></span></font></p> <p class=MsoNormal style='text-align:justify'><font size=3 face="Times New Roman"><span style='font-size:12.0pt;font-family:"Times New Roman"'>&nbsp;</span></font></p> </div> </body> </html> <br /><hr><br /><html> <head> <title>Rule 67:16:02:15 Reimbursement for services provided by nurse practitioner, clinical nurse specialist, or physician assistant.</title> <META NAME="Keywords" Content="Administrative Rules 67:16:02:15"> <META NAME="Description" Content="Administrative Rules 67:16:02:15 Reimbursement for services provided by nurse practitioner, clinical nurse specialist, or physician assistant."> <meta http-equiv=Content-Type content="text/html; charset=windows-1252"> <meta name=Generator content="Microsoft Word 15 (filtered)"> <style> <!-- /* Font Definitions */ @font-face {font-family:"Cambria Math"; panose-1:2 4 5 3 5 4 6 3 2 4;} @font-face {font-family:Calibri; panose-1:2 15 5 2 2 2 4 3 2 4;} @font-face {font-family:Times; panose-1:2 2 6 3 5 4 5 2 3 4;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {margin:0in; margin-bottom:.0001pt; font-size:10.0pt; font-family:"Times",serif; color:black;} a:link, span.MsoHyperlink {color:blue; text-decoration:underline;} a:visited, span.MsoHyperlinkFollowed {color:#954F72; text-decoration:underline;} .MsoChpDefault {font-size:10.0pt; font-family:"Calibri",sans-serif; color:black;} @page WordSection1 {size:8.5in 11.0in; margin:49.7pt 1.0in 49.7pt 63.35pt;} div.WordSection1 {page:WordSection1;} --> </style> </head> <body lang=EN-US link=blue vlink="#954F72"> <div class=WordSection1> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>67:16:02:15.&nbsp;&nbsp;Reimbursement for services provided by nurse practitioner, clinical nurse specialist, or physician assistant.</b> Except for laboratory services, radiological services, immunizations, and supplies, services provided by a nurse practitioner, a clinical nurse specialist, or a physician assistant are reimbursed at 90 percent of the fee established under this chapter.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Reimbursement for laboratory services, radiological services, immunizations, and supplies provided by a nurse practitioner, a clinical nurse specialist, or a physician assistant are reimbursed according to &#167;&nbsp;67:16:02:03.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>Source:</b> 16 SDR 234, effective July 2, 1990; 18 SDR 107, effective December 29, 1991; 19 SDR 26, effective August 23, 1992; 34 SDR 68, effective September 12, 2007; 37 SDR 236, effective June 28, 2011; 37 SDR 236, adopted June 8, 2011, effective July 1, 2012; 44 SDR 94, effective December 4, 2017.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&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</A></span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>(1)(2)</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&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</A></span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>(1)(2)</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> </div> </body> </html> <br /><hr><br /><html> <head> <title>Rule 67:16:02:16 Billing requirements -- Modifier codes -- Provider identification numbers.</title> <META NAME="Keywords" Content="Administrative Rules 67:16:02:16"> <META NAME="Description" Content="Administrative Rules 67:16:02:16 Billing requirements -- Modifier codes -- Provider identification numbers."> <meta http-equiv=Content-Type content="text/html; charset=windows-1252"> <meta name=Generator content="Microsoft Word 15 (filtered)"> <style> <!-- /* Font Definitions */ @font-face {font-family:"Cambria Math"; panose-1:2 4 5 3 5 4 6 3 2 4;} @font-face {font-family:Times; panose-1:2 2 6 3 5 4 5 2 3 4;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {margin:0in; margin-bottom:.0001pt; font-size:10.0pt; font-family:"Times",serif; color:black;} a:link, span.MsoHyperlink {color:blue; text-decoration:underline;} a:visited, span.MsoHyperlinkFollowed {color:#954F72; text-decoration:underline;} .MsoChpDefault {font-size:10.0pt; color:black;} @page WordSection1 {size:8.5in 11.0in; margin:1.0in 1.25in 1.0in 1.25in;} div.WordSection1 {page:WordSection1;} --> </style> </head> <body lang=EN-US link=blue vlink="#954F72"> <div class=WordSection1> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>67:16:02:16.&nbsp;&nbsp;Billing requirements -- Modifier codes -- Provider identification numbers.</b> A claim submitted under this chapter must be submitted at the provider's usual and customary charge.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; The laboratory </span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>that</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> performed the laboratory test </span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>shall</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> submit the claim for the test.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; If relevant, the claim shall identify the modifying circumstance of a service or procedure by the addition of the applicable modifier code to the procedure code.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; A claim submitted for multiple surgeries must contain the applicable procedure code for the primary surgical procedure. All other procedures performed during the same operating session must be billed using the applicable procedure code </span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>and </span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>modifier 51. A bilateral procedure or a surgical procedure which cannot stand alone but which is performed as a part of a primary surgical procedure is not considered a multiple surgical procedure.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; A claim submitted by a clinical nurse specialist, a nurse practitioner, or a physician assistant must contain the nurse practitioner's, the clinical nurse specialist's, or the physician assistant's provider identification number and may not be submitted under the supervising physician's provider identification number.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; A claim submitted for immunizations must contain the applicable procedure code for the administration of the vaccine and an additional procedure code for the vaccine itself. If the vaccine is supplied by the state, the billing code for the vaccine must contain the two-letter modifier of SL.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>Source:</b> 16 SDR 234, effective July 2, 1990; 17 SDR 200, effective July 1, 1991; 1921 SDR 165, effective May 3, 1993; 23 SDR 38, effective September 26, 1996; 34 SDR 68, effective September 12, 2007; 44 SDR 94, effective December 4, 2017.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&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</A></span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>(1)(2)</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&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</A></span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>(1)(2)</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>Cross-References:</b></span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Required modifier codes, &#167;&nbsp;67:16:02:03.03.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Third-party liability, ch 67:16:26.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Claims, ch 67:16:35.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> </div> </body> </html> <br /><hr><br /><html> <head> <title>Rule 67:16:02:16.01 Billing requirements -- Implantable contraceptive capsules and obstetrical services.</title> <META NAME="Keywords" Content="Administrative Rules 67:16:02:16.01"> <META NAME="Description" Content="Administrative Rules 67:16:02:16.01 Billing requirements -- Implantable contraceptive capsules and obstetrical services."> <meta http-equiv=Content-Type content="text/html; charset=windows-1252"> <meta name=Generator content="Microsoft Word 15 (filtered)"> <style> <!-- /* Font Definitions */ @font-face {font-family:"Cambria Math"; panose-1:2 4 5 3 5 4 6 3 2 4;} @font-face {font-family:Times; panose-1:2 2 6 3 5 4 5 2 3 4;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {margin:0in; margin-bottom:.0001pt; font-size:10.0pt; font-family:"Times",serif; color:black;} a:link, span.MsoHyperlink {color:blue; text-decoration:underline;} a:visited, span.MsoHyperlinkFollowed {color:#954F72; text-decoration:underline;} .MsoChpDefault {font-size:10.0pt; color:black;} @page WordSection1 {size:8.5in 11.0in; margin:1.0in 1.0in 1.0in 1.0in;} div.WordSection1 {page:WordSection1;} --> </style> </head> <body lang=EN-US link=blue vlink="#954F72"> <div class=WordSection1> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>67:16:02:16.01.&nbsp;&nbsp;Billing requirements -- Implantable contraceptive capsules and obstetrical services.</b> When computing the rate of reimbursement, the department uses the fee schedules established under the provisions of &#167;&nbsp;67:16:02:01.01. 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></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 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 class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Providers must use the appropriate CPT code to indicate obstetric care, antepartum care, delivery, and postpartum care. When applicable, providers must 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 class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; A claim submitted for postpartum care is limited to hospital and office visits in the </span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>6</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>0 days following vaginal or cesarean section delivery.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; The guidelines adopted in &#167;&nbsp;67:16:01:25 apply unless otherwise noted in this chapter.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>Source:</b> 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 style='font-size:12.0pt;font-family:"Times New Roman",serif'>; 43 SDR 80, effective December 5, 2016</span><span style='font-size:12.0pt;font-family: "Times New Roman",serif'>.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&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.</A></span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&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.</A></span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> </div> </body> </html> <br /><hr><br /><html> <head> <title>Rule 67:16:02:17 Claim requirements.</title> <META NAME="Keywords" Content="Administrative Rules 67:16:02:17"> <META NAME="Description" Content="Administrative Rules 67:16:02:17 Claim requirements."> <meta http-equiv=Content-Type content="text/html; charset=windows-1252"> <meta name=Generator content="Microsoft Word 15 (filtered)"> <style> <!-- /* Font Definitions */ @font-face {font-family:"Cambria Math"; panose-1:2 4 5 3 5 4 6 3 2 4;} @font-face {font-family:Times; panose-1:2 2 6 3 5 4 5 2 3 4;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {margin:0in; margin-bottom:.0001pt; font-size:10.0pt; font-family:"Times",serif; color:black;} a:link, span.MsoHyperlink {color:blue; text-decoration:underline;} a:visited, span.MsoHyperlinkFollowed {color:#954F72; text-decoration:underline;} .MsoChpDefault {font-size:10.0pt; color:black;} @page WordSection1 {size:8.5in 11.0in; margin:1.0in 1.0in 1.0in 1.0in;} div.WordSection1 {page:WordSection1;} --> </style> </head> <body lang=EN-US link=blue vlink="#954F72"> <div class=WordSection1> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>67:16:02:17.&nbsp;&nbsp;Claim requirements.</b> A claim for services provided under this chapter must be submitted on a form or in an electronic format that contains the following information:</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (1)&nbsp;&nbsp;The recipient's full name;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (2)&nbsp;&nbsp;The recipient's medical assistance identification number from the recipient's medical assistance identification card;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (3)&nbsp;&nbsp;Third-party liability information required under chapter 67:16:26;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (4)&nbsp;&nbsp;Date of service;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (5)&nbsp;&nbsp;Place of service;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (6)&nbsp;&nbsp;The provider's usual and customary charge. The provider may not subtract other third-party or cost-sharing payments from this charge;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (7)&nbsp;&nbsp;Units of service furnished if more than one;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (8)&nbsp;&nbsp;The applicable procedure codes from either the <b>Health Care Common Procedure Coding System</b> (HCPCS) or the <b>Current Procedural Terminology</b></span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> (CPT)</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (9)&nbsp;&nbsp;The applicable diagnosis codes</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>, as</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> adopted in &#167;&nbsp;67:16:01:26;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (10)&nbsp;&nbsp;The provider's name and National Provider Identification (NPI) number;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (11)&nbsp;&nbsp;If the provider is a group provider, the National Provider Identification number of the physician</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'> or applicable, enrolled provider</span><span style='font-size:12.0pt; font-family:"Times New Roman",serif'> who provided the care or service;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (12)&nbsp;&nbsp;Type of service; and</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (13)&nbsp;&nbsp;The modifier code listed in &#167;&nbsp;67:16:02:03.03, as applicable.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; A separate claim must be submitted for each recipient.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>Source:</b> 17 SDR 4, effective July 16, 1990; 17 SDR 22, effective August 14, 1990; 17 SDR 200, effective July 1, 1991; 18 SDR 78, effective November 4, 1991; 19 SDR 26, effective August 23, 1992; 19 SDR 128, effective March 11, 1993; 19 SDR 165, effective May 3, 1993; 20 SDR 149, effective March 21, 1994; 21 SDR 183, effective April 30, 1995; 34 SDR 68, effective September 12, 2007; 40 SDR 122, effective January 7, 2014; 42 SDR 51, effective October 13, 2015; 44 SDR 94, effective December 4, 2017.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&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</A></span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>(2)(4)</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&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</A></span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>(2)(4)</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>Cross-References:</b></span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Claims, ch 67:16:35.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Use of CPT, &#167;&nbsp;67:16:01:25.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Use of HCPCS, &#167;&nbsp;67:16:01:27.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>Note:</b> The CMS 1500 form substantially meets the requirements of this rule and its content and appearance are acceptable to the department. These forms are available for direct purchase through the Superintendent of Documents, U.S. Government Printing Office, Washington, D.C. 20402.&nbsp; (202) 783-3238 - pricing desk.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> </div> </body> </html> <br /><hr><br /><html> <head> <title>Rule 67:16:02:18 Repealed.</title> <META NAME="Keywords" Content="Administrative Rules 67:16:02:18"> <META NAME="Description" Content="Administrative Rules 67:16:02:18 Repealed."> <meta http-equiv=Content-Type content="text/html; charset=windows-1252"> <meta name=Generator content="Microsoft Word 15 (filtered)"> <style> <!-- /* Font Definitions */ @font-face {font-family:"Cambria Math"; panose-1:2 4 5 3 5 4 6 3 2 4;} @font-face {font-family:Times; panose-1:2 2 6 3 5 4 5 2 3 4;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {margin:0in; margin-bottom:.0001pt; font-size:10.0pt; font-family:"Times",serif; color:black;} a:link, span.MsoHyperlink {color:blue; text-decoration:underline;} a:visited, span.MsoHyperlinkFollowed {color:#954F72; text-decoration:underline;} .MsoChpDefault {font-size:10.0pt; color:black;} @page WordSection1 {size:8.5in 11.0in; margin:1.0in 1.0in 1.0in 1.0in;} div.WordSection1 {page:WordSection1;} --> </style> </head> <body lang=EN-US link=blue vlink="#954F72"> <div class=WordSection1> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>67:16:02:18.&nbsp;&nbsp;Certain services exempt from diagnosis code requirements.</b> </span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>Repealed</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>Source:</b> 17 SDR 4, effective July 16, 1990; 42 SDR 51, effective October 13, 2015</span><span style='font-size:12.0pt;font-family:"Times New Roman",serif'>; 43 SDR 80, effective December 5, 2016</span><span style='font-size:12.0pt;font-family: "Times New Roman",serif'>.</span></p> <p class=MsoNormal style='text-align:justify'><span style='font-size:12.0pt; font-family:"Times New Roman",serif'>&nbsp;</span></p> </div> </body> </html> <br /><hr><br /><html xmlns:v="urn:schemas-microsoft-com:vml" xmlns:o="urn:schemas-microsoft-com:office:office" xmlns:w="urn:schemas-microsoft-com:office:word" xmlns="http://www.w3.org/TR/REC-html40"> <head> <title>Rule 67:16:02:19 Application of other chapters.</title> <META NAME="Keywords" Content="Administrative Rules 67:16:02:19"> <META NAME="Description" Content="Administrative Rules 67:16:02:19 Application of other chapters."> <meta http-equiv=Content-Type content="text/html; 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font-family:"Times New Roman";} </style> <![endif]--><!--[if gte mso 9]><xml> <o:shapedefaults v:ext="edit" spidmax="1026"/> </xml><![endif]--><!--[if gte mso 9]><xml> <o:shapelayout v:ext="edit"> <o:idmap v:ext="edit" data="1"/> </o:shapelayout></xml><![endif]--> </head> <body lang=EN-US style='tab-interval:.5in'> <div class=Section1> <p class=MsoNormal style='text-align:justify;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><span style='mso-tab-count:1'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span><b style='mso-bidi-font-weight:normal'>67:16:02:19.<span class=GramE>&nbsp;&nbsp;Application</span> of other chapters.</b> In addition to the rules contained in this chapter, providers and recipients must meet the requirements of chapters 67:16:01, 67:16:26, 67:16:33, 67:16:34, 67:16:35, and 67:16:39.<o:p></o:p></span></p> <p class=MsoNormal style='text-align:justify;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p> <p class=MsoNormal style='text-align:justify;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><span style='mso-tab-count:1'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span><b style='mso-bidi-font-weight:normal'>Source:</b> 17 SDR 184, effective June 6, 1991; 34 SDR 68, effective September 12, 2007.<o:p></o:p></span></p> <p class=MsoNormal style='text-align:justify;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><span style='mso-tab-count:1'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span><b style='mso-bidi-font-weight:normal'>General Authority:</b> SDCL <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=28-6-1">28-6-1.</A><o:p></o:p></span></p> <p class=MsoNormal style='text-align:justify;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><span style='mso-tab-count:1'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span><b style='mso-bidi-font-weight:normal'>Law Implemented:</b> SDCL <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=28-6-1">28-6-1.</A><o:p></o:p></span></p> <p class=MsoNormal style='text-align:justify;tab-stops:.4in .6in .9in 1.1in 1.4in 1.6in 1.9in 2.1in 2.4in 2.6in 2.9in 3.1in 3.4in 3.6in 3.9in 4.1in'><span style='font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p> </div> </body> </html>