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Medicaid Provider Fee Schedule

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

Tracking Log for Provider Fee Updates

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.

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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.

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  1. Subject to the terms and conditions contained in this Agreement, you, your employees, and agents are authorized to use CDT only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. Use of CDT is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. You acknowledge that the ADA holds all copyright, trademark and other rights in CDT. You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights notices included in the materials
  2. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CDT for resale and/or license, transferring copies of CDT to any party not bound by this agreement, creating any modified or derivative work of CDT, or making any commercial use of CDT. License to use CDT for any use not authorized herein must be obtained through the American Dental Association, 211 East Chicago Avenue, Chicago, IL 60611. Applications are available at the American Dental Association website: http://www.ADA.org/.
  3. Applicable Federal Acquisition Regulation Clauses (FARS)\Department of Defense Federal Acquisition Regulation Supplement (DFARS) Restrictions Apply to Government use. This product includes Current Dental Terminology ("CDT'"), which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable, which was developed exclusively at private expense by the American Dental Association, 211 East Chicago Avenue, Chicago, Illinois, 60611. 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) (June 1995) and/or subject to the restrictions of DFARS 227.7202-l(a) (June 1995) 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
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