The Diagnosis Look-up Tool can be used by providers to identify the circumstances when a diagnosis code is payable by South Dakota Medicaid. Providers should review all fields to determine if a code is payable. The status indicated on the tool is not a guarantee of payment. Claims may deny for other reasons such as system edits or failure to meet South Dakota Medicaid coverage criteria. A description of the fields is provided below.
Diagnosis Code: This is the ICD-10 diagnosis code.
Diagnosis Description: This is a description of the diagnosis code.
Billing Status
Requires Review
Minimum Age and Maximum Age: The recipient’s age on the date of service must be within this age range. If the recipient is younger than the minimum age on the date of service, the code is not payable. If the recipient is older than the maximum age on the date of service, the code is not payable. Codes with a minimum age of “0” and a maximum age of “0” are limited to recipients younger than 12 months and are payable if the diagnosis description indicates it is appropriate for the recipient.
Mental Health
SUD
Chiropractor
Start Date and End Date: The date of service must be within this date span for the code to be payable. If the end date is “12/31/9999” the code is an active ICD-10 diagnosis code and has no end date. Claims must be submitted within South Dakota Medicaid’s timely filing standards. Refer to the General Claims Guidance manual for more information about timely filing.
Last updated 05/25/2023. Please note that information displayed on the tool is not a guarantee of payment. Claims may deny for other reasons such as system edits or services not meeting South Dakota Medicaid coverage criteria.