General Requirements
These manuals include requirements that are applicable to most or all providers and should be reviewed in addition to claim instructions and provider specific manuals.
Within each manual the keyboard shortcut Ctrl+F (Control Find) will open a search bar allowing you search for specific words or phrases throughout the entire document.
Provider Basics
Care Management Programs
CMS 1500 Claim Instructions
UB04 Claim Instructions
Dental Provider Manuals
Institutional Provider Manuals
Professional Provider Manuals
Pharmacy Services
HCBS Waiver Services
Tracking Log
Coding Manuals
All Medicaid claims must be submitted using standard billing codes. Providers are required to use the nationally recognized coding systems listed below. The applicable edition must be based on the date of service.
The administrative simplification provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA, Title II) requires the United States Department of Health and Human Services to establish national standards for electronic health care transactions and national identifiers for providers, health plans and employers. South Dakota Medicaid is required by federal law to conform to the national standards. Listed below is a series of manuals detailing the situational data elements and plan-specific values that must be included in transactions that are transmitted electronically to South Dakota Medicaid.
License for Use of Physicians' Current Procedural Terminology (CPT)
End User Point and Click Agreement
             Current  Procedural Terminology (CPT) codes, descriptions and other data only are  copyright 2015 American Medical Association (AMA).
             You,  your employees, and agents are authorized to use CPT only as contained in the  following authorized materials internally within your organization within the  United States for the sole use by yourself, employees, and agents. Use is  limited to use in Medicare, Medicaid, or other programs administered by the  Centers for Medicare & Medicaid Services (CMS). You agree to take all  necessary steps to insure that your employees and agents abide by the terms of  this agreement.
             Any use  not authorized herein is prohibited, including by way of illustration and not  by way of limitation, making copies of CPT for resale and/or license,  transferring copies of CPT to any party not bound by this agreement, creating  any modified or derivative work of CPT, or making any commercial use of CPT.  License to use CPT for any use not authorized herein must be obtained through  the AMA, CPT Intellectual Property Services, 515 North State Street, Chicago,  IL 60610. Applications are available on the AMA website, https://www.ama-assn.org/practice-management/cpt/ama-cpt-licensing-overview 
Applicable FARS/DFARS restrictions apply to government use. This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60654. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (November 1995) and/or subject to the restrictions of DFARS 227.7202-l(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements.
AMA  Disclaimer of Warranties and Liabilities
             CPT is provided “as is” without warranty of any kind, either expressed or  implied, including but not limited to, the implied warranties of  merchantability and fitness for a particular purpose. No fee schedules, basic  unit, relative values or related listings are included in CPT. The AMA does not  directly or indirectly practice medicine or dispense medical services. The  responsibility for the content of this file/product is with CMS and no  endorsement by the AMA is intended or implied. The AMA disclaims responsibility  for any consequences or liability attributable to or related to any use,  non-use, or interpretation of information contained or not contained in this  file/product. This agreement will terminate upon notice if you violate its  terms. The AMA is a third party beneficiary to this Agreement.
CMS Disclaimer
             The scope of this license is determined by the AMA, the copyright holder. Any  questions pertaining to the license or use of the CPT must be addressed to the  AMA. End Users do not act for or on behalf of CMS. CMS DISCLAIMS RESPONSIBILITY  FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CPT. CMS WILL NOT BE  LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER  INACCURACIES IN THE INFORMATION OR MATERIAL CONTAINED ON THIS PAGE. In no event  shall CMS be liable for direct, indirect, special, incidental, or consequential  damages arising out of the use of such information or material.
             Should  the foregoing terms and conditions be acceptable to you, indicate your  agreement and acceptance by clicking on the button labeled "I  ACCEPT."
             
             Point  and Click License for Use of Current Dental Terminology (CDT™)
             End User License Agreement
             
             These  materials contain Current Dental Terminology (CDT™), Copyright © 2015 American  Dental Association (ADA). All rights reserved. CDT is a trademark of the ADA.
             
             THE  LICENSE GRANTED HEREIN IS EXPRESSLY CONDITIONED UPON YOUR ACCEPTANCE OF ALL  TERMS AND CONDITIONS CONTAINED IN THIS AGREEMENT. BY CLICKING ON THE BUTTON  LABELED “I ACCEPT,” YOU HEREBY ACKNOWLEDGE THAT YOU HAVE READ, UNDERSTOOD, AND  AGREED TO ALL TERMS AND CONDITIONS SET FORTH IN THIS AGREEMENT.
             
           IF YOU  DO NOT AGREE WITH ALL TERMS AND CONDITIONS SET FORTH HEREIN, CLICK ON THE  BUTTON LABELED “I DO NOT ACCEPT” AND EXIT FROM THIS COMPUTER SCREEN.
IF YOU ARE ACTING ON BEHALF OF AN ORGANIZATION, YOU REPRESENT THAT YOU ARE AUTHORIZED TO ACT ON BEHALF OF SUCH ORGANIZATION AND THAT YOUR ACCEPTANCE OF THE TERMS OF THIS AGREEMENT CREATES A LEGALLY ENFORCEABLE OBLIGATION OF THE ORGANIZATION. AS USED HEREIN, “YOU” AND “YOUR” REFER TO YOU AND ANY ORGANIZATION ON BEHALF OF WHICH YOU ARE ACTING.
The license granted herein is expressly conditioned upon your acceptance of all terms and conditions contained in this agreement. If the foregoing terms and conditions are acceptable to you, indicate your agreement by clicking on the button labeled “I ACCEPT.” If you do not agree to the terms and conditions, you may not access or use the software. Instead, you must click on the button labeled “I DO NOT ACCEPT” and exit from this computer screen.