Lynne A. Valenti
Cabinet Secretary

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Provider Fee Schedules

The fee schedules below describe services covered by South Dakota Medicaid. Fee schedules are listed by provider type. Fee schedules are subject to review and amendment under the provisions of Administrative Rule of South Dakota.

The Department requires providers to bill claims using authorized modifier codes when applicable to the service provided. Click the link below to view the list of authorized modifier codes.

Ambulatory Surgery Center

Document Name Latest Version Previous Version
Facility Grouper pdf pdf
Surgical Procedures pdf pdf

Behavioral Health

Document Name Latest Version Previous Version
Chemical Dependency Programs pdf

pdf

Community Mental Health Centers pdf pdf

Dental Services

Document Name Latest Version Previous Version
Adult Services pdf pdf
Children Services (up to age 21) pdf pdf

Hospital Services

Document Name Latest Version Previous Version
List of Diagnostic Related Groups (DRG's) pdf pdf
Outlier Threshold pdf

pdf

Swing Bed Hospitals pdf  pdf  
In-State DRG-Exempt Perinatal Units, Rehabilitation Units, and Psychiatric Units pdf pdf 
Outpatient Hospital Laboratory Noncritical Access pdf pdf  
Outpatient Hospital Laboratory Critical Access pdf pdf  
Outpatient Hospital Nonlaboratory Noncritical Access pdf pdf
Outpatient Hospital Nonlaboratory Critical Access pdf pdf

Mental Health Services

Document Name Latest Version Previous Version
Provided by Independent Mental Health Practitioners pdf pdf
Provided by DRG-Exempt Psych Unit pdf pdf

Nutritional Therapy

Document Name Latest Version Previous Version
Enteral Therapy for Children (up to age 21) - DME pdf pdf
Enteral Therapy for Children (up to age 21) - Pharmacy
Enteral Therapy for Adults - DME pdf pdf
Enteral Therapy for Adults - Pharmacy
Parenteral Therapy - DME pdf pdf
Parenteral Therapy - Pharmacy

Physician Services

Document Name Latest Version Previous Version
Laboratory Procedures -Primary Care Phys pdf pdf 
Laboratory Procedures - Others
Nonlaboratory Procedures - Primary Care Physicians pdf pdf
Nonlaboratory Procedures - Others
Enhanced Primary Care Payments pdf pdf

Podiatric Services

Document Name Latest Version Previous Version
Surgical Procedures pdf pdf
Nonsurgical Procedures

Other Services

Document Name Latest Version Previous Version
Chiropractic Services pdf pdf
Diabetes Education Services pdf pdf
Home Health Services pdf pdf
Durable Medical Equipment pdf pdf
Pharmacy Dispensing Fee pdf  pdf  
Transportation Services pdf pdf
Vision Services pdf pdf
Private Duty Nursing/Extended Home Health Aide pdf pdf
Hospice Rates pdf

pdf

Medicaid Nursing Facility Clinical Classifications -- RUG's 34 pdf pdf