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.

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	N/A
List of Diagnostic Related Groups (DRG's)	excel pdf	excel pdf
Outlier Threshold	excel pdf	excel pdf
Swing Bed Hospitals	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	excel pdf
Enteral Therapy for Adults - DME	excel pdf	excel pdf
Enteral Therapy for Adults - Pharmacy	excel pdf	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 Physicians	excel pdf	excel pdf
Laboratory Procedures - Others	excel pdf	excel pdf
Nonlaboratory Procedures - Primary Care Physicians	excel pdf	excel pdf
Nonlaboratory Procedures - Others	excel pdf	excel pdf

Podiatric Services

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