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Provider Information

Provider Fee Schedule

Below are services covered by the South Dakota Medical Assistance Program including: provider services, the associated relative value units, a fee schedule status indicator and various payment policy indicators needed for payment.

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   excel        pdf   excel        pdf
Surgical Procedures   excel        pdf   excel        pdf

Birth Center

Document Name Latest Version Previous Version
Facility Fee   excel        pdf

N/A

Community and Behavioral Health

Document Name Latest Version Previous Version
Chemical Dependency Programs   excel        pdf

  excel        pdf

Community Mental Health Centers   excel        pdf   excel        pdf

Dental Services

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

Hospital Services

Document Name Latest Version Previous Version
Disproportionate Share Hospital Program Payments Table   excel        pdf   excel        pdf
Graduate Medical Education Pool   excel        pdf   excel        pdf 
List of Diagnostic Related Groups (DRG's)   excel        pdf   excel        pdf
Outlier Threshold   excel        pdf

  excel        pdf

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

Mental Health Services

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

Nutritional Therapy

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

Physician Services

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

Podiatric Services

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

Other Services

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

  excel        pdf

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