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The following implanted devices require the surgeon to seek authorization for payment from the South Dakota Medical Assistance Program.
These authorizations are assigned based upon medical necessity criteria (ARSD 67:16:01:06.02) using Medicare’s coverage policy as standard of care for diagnosis and condition. For cases meeting criteria, a single episode of service authorization is issued to the surgeon performing the implantation. The surgeon provides the authorization notice to the facility where the procedure will be performed. Invoices for the actual devices may be requested by the South Dakota Medical Assistance Program from facilities billing Revenue Codes 270-279.