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 |
BabyReady Program | 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 |
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 |
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