The Medicaid fee schedules listed below are organized by provider type. These schedules typically contain procedure codes, descriptions and the maximum reimbursement rates allowed. Providers must bill Medicaid based on their usual and customary charges for services rendered to the general public, rather than relying solely on the fee schedule rates. It’s important to note that the rates serve as informational resources for providers and do not guarantee payment at the specific rate listed. Additionally, these schedules are subject to review and modifications in accordance with the Administrative Rule of South Dakota (ARSD).
The rate of payment for “Price By Report” is generally the percent of the usual and customary charge established in ARSD 67:16:02:03.
The Department requires providers to bill claims using authorized modifier codes when applicable to the service provided.
Ambulatory Payment Classification (APC) | Payment System Indicator (PSI) Descriptions | ||||
APC Fee Schedule |
2024 Q1 | 2024 Q2 | 2024 Q3 | 2024 Q4 |
Ambulatory Surgery Center and Specialized Surgical Hospitals | ||
Facility Grouper | SFY25 | SFY24 |
Surgical Procedures | CY24 | CY23 |
Behavioral Health | ||
Substance Use Disorder | SFY25 | SFY24 |
Community Mental Health Centers | SFY25 | SFY24 |
Independent Mental Health Practitioners | SFY25 | SFY24 |
Drugs, Biologicals and Radiopharmaceuticals | ||||
Drugs, Biologicals and Radiopharmaceuticals |
2024 Q1 | 2024 Q2 | 2024 Q3 | 2024 Q4 |
Dental Services | ||
Adult Services | SFY25 | SFY24 |
Children Services (up to age 21) | SFY25 | SFY24 |
Hospital Services | Diagnosis Related Groups (DRG's) | ||
List of Diagnostic Related Groups (DRG's) | CY24 | CY23 |
Outlier Threshold | CY24 | CY23 |
Swing Bed Hospitals | SFY25 | SFY24 |
In-State DRG-Exempt Perinatal Units, Rehabilitation Units and Psychiatric Units | SFY25 | SFY24 |
Hospital Disproportionate Share Payments | SFY25 | SFY24 |
Graduate Medical Education Payments | SFY25 | SFY24 |
Laboratory Services | ||
Laboratory Services | SFY25 | SFY24 |
Nursing Facility Rates | ||
Intermediate Care Facility | SFY25 | SFY24 |
Medicaid Nursing Facility Clinical Classifications - RUG's 34 | SFY23 | |
Nursing Facility Patient Driven Payment Model(PDPM) Case Mix Weights | SFY25 | SFY24 |
Nursing Facility Rates | SFY25 | SFY24 |
Nutritional Therapy | ||
Enteral Therapy for Children (up to age 21) - DME/Pharmacy | SFY25 | SFY24 |
Enteral Therapy for Adults - DME/Pharmacy | SFY25 | SFY24 |
Parenteral Therapy - DME/Pharmacy | SFY25 | SFY24 |
Physician Services | ||
Anesthesia Services | SFY25 | SFY24 |
Physician Services | SFY25 | SFY24 |
Podiatric Services | ||
Surgical/Nonsurgical Procedures | SFY25 | SFY24 |
Other Services | ||
Applied Behavior Analysis | SFY25 | SFY24 |
Chiropractic Services | SFY25 | SFY24 |
Community Health Worker Agencies | SFY25 | SFY24 |
Diabetes Education Services | SFY25 | SFY24 |
Dietitian and Nutritionist Services | SFY25 | SFY24 |
Durable Medical Equipment, Prosthetics, Orthotics, and Supplies | SFY25 | SFY24 |
Freestanding Birth Centers | SFY25 | SFY24 |
Health Home Per Member Per Month Payment | SFY25 | SFY24 |
Health Home Quality Incentive Payments | SFY25 | SFY24 |
Home Health Services | SFY25 | SFY24 |
Hospice Rates | FFY25 | FFY24 |
Personal Care Agency Services | SFY25 | SFY24 |
Pharmacy Dispensing Fee | SFY25 | SFY24 |
Pregnancy Program | SFY25 | SFY24 |
Primary Care Program Per Member Per Month Payment | SFY25 | SFY24 |
Private Duty Nursing/Extended Home Health Aide | SFY25 | SFY24 |
Renal Dialysis | SFY25 | SFY24 |
Transportation Services | SFY25 | SFY24 |
Vision Services | SFY25 | SFY24 |
HCBS Waiver Services | ||
Assistive Daily Living Services Waiver | SFY25 | SFY24 |
Family Support 360 Waiver | SFY25 | SFY24 |
CHOICES DD Waiver | SFY25 | SFY24 |
HOPE Waiver | SFY25 | SFY24 |
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.