<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.sc9812c6e-922e-42ec-b8e2-5acfe128885cP0 { 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.sc9812c6e-922e-42ec-b8e2-5acfe128885cC0 { color: black; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.sc9812c6e-922e-42ec-b8e2-5acfe128885cC0-000000 { color: #0000FF; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.sc9812c6e-922e-42ec-b8e2-5acfe128885cC0-000001 { color: black; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: bold; margin: 0; padding: 0; } span.sc9812c6e-922e-42ec-b8e2-5acfe128885c000002 { color: black; background: white; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } span.sc9812c6e-922e-42ec-b8e2-5acfe128885cC0-000003 { color: #0000FF; background: white; font-family: 'Times New Roman', 'serif'; font-size: 12pt; font-style: normal; font-weight: normal; margin: 0; padding: 0; } </style></head><body><div><p dir="ltr" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">    </span><a href="https://sdlegislature.gov/Rules?Rule=67:16:41:14"><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0-000000">67:16:41:14</span></a><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0-000001">.  Billing requirements.</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0"> The following </span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">requirements </span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">apply to services billed under this chapter:</span></p><p dir="ltr" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885c000002"> </span></p><p dir="ltr" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">    (1)  </span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">Each</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0"> claim must contain the medical assistance provider identification number of the individual delivering the service;</span></p><p dir="ltr" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885c000002"> </span></p><p dir="ltr" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">    (2)  </span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">A</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0"> claim </span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">may not be submitted </span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">for a diagnostic assessment </span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">t</span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">h</span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">at</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0"> exceeds four hours</span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">,</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0"> unless there has been a break of at least 12 months in the delivery of mental health treatment to the recipient;</span></p><p dir="ltr" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885c000002"> </span></p><p dir="ltr" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">    (3)  </span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">A</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0"> claim </span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">may not be submitted </span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">for a diagnostic assessment until the assessment is completed and recorded in the recipient's clinical record;</span></p><p dir="ltr" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885c000002"> </span></p><p dir="ltr" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">    (4)  </span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">A</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0"> claim </span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">may not be submitted </span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">for mental health treatment provided before the diagnostic assessment is completed</span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">, except for treatment provided with a provisional diagnosis of a mental health disorder during the 30-day time period the mental health provider has to complete the diagnostic assessment</span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">;</span></p><p dir="ltr" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885c000002"> </span></p><p dir="ltr" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">    (5)  </span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">A</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0"> claim </span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">may not be submitted </span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">for mental health services provided after the fourth face-to-face </span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">or telehealth </span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">session with</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0"> the</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0"> recipient and before the effective date of the treatment plan;</span></p><p dir="ltr" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885c000002"> </span></p><p dir="ltr" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">    (6)  If a psychotherapy session is provided to more than one individual</span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">,</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0"> the</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0"> </span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">service must be billed as family or group psychotherapy, whichever is appropriate, even if the</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0"> </span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">individual is the only one eligible for the medical assistance program;</span></p><p dir="ltr" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885c000002"> </span></p><p dir="ltr" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">    (7)  </span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">I</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">f a recipient is involved in a psychotherapy session only as part of a family or group session for </span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">the </span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">treatment of another family member who is a mental health client</span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">, a claim for the session may not be submitted for that recipient</span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">;</span></p><p dir="ltr" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885c000002"> </span></p><p dir="ltr" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">    (8)  Except for a psychiatric diagnostic interview examination and a diagnostic assessment, a claim </span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">may not be submitted </span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">for mental health treatment</span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">,</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0"> </span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">unless</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0"> the recipient </span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">has</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0"> a primary diagnosis of a mental </span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">health </span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">disorder; and</span></p><p dir="ltr" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885c000002"> </span></p><p dir="ltr" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">    (9)  </span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">A</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0"> claim </span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">may be submitted </span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">for each eligible recipient</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0"> who is</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0"> in a family or group psychotherapy session </span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">and</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0"> is actively receiving psychotherapy</span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">, if</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0"> each family or group member for whom services are billed to the medical assistance program ha</span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">s</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0"> a complete clinical record </span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">t</span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">h</span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">at</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0"> meets the requirements of § </span><a href="https://sdlegislature.gov/Rules?Rule=67:16:41:08"><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0-000003">67:16:41:0</span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0-000003">8</span></a><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">.</span></p><p dir="ltr" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885c000002"> </span></p><p dir="ltr" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">    </span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">A</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0"> provider </span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">shall</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0"> submit claims at the provider's usual and customary charge</span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">.</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0"> </span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">A</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0"> claim may contain only those procedure codes listed </span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">on the department's fee schedule website</span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">.</span></p><p dir="ltr" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885c000002"> </span></p><p dir="ltr" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">    </span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0-000001">Source:</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0"> 22 SDR 6, effective July 26, 1995; 26 SDR 168, effective July 1, 2000; 37 SDR 53, effective September 23, 2010; 46 SDR 50, effective October 10, 2019</span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">; 48 SDR 39, effective October 3, 2021; 49 SDR 21, effective September 12, 2022</span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">.</span></p><p dir="ltr" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">    </span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0-000001">General Authority:</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0"> SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=28-6-1"><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0-000003">28-6-1</span></a><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">.</span></p><p dir="ltr" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">    </span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0-000001">Law Implemented:</span><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0"> SDCL </span><a href="https://sdlegislature.gov/Statutes?Statute=28-6-1"><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0-000003">28-6-1</span></a><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">(1)(2)</span><span style="white-space: pre-wrap;" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cC0">.</span></p><p dir="ltr" class="sc9812c6e-922e-42ec-b8e2-5acfe128885cP0"><span style="white-space: pre-wrap;" xml:space="preserve" class="sc9812c6e-922e-42ec-b8e2-5acfe128885c000002"> </span></p></div></body></html>