South Dakota Administrative Rules
Title 67 - Department of Social Services
Article 67:16 - Covered medical services
Chapter 67:16:03 - Hospital services
Section 67:16:03:03 - Outpatient hospital services covered

(1) Laboratory services;

(2) X ray and other radiology services;

(3) Emergency room services;

(4) Medical supplies used during treatment at the facility;

(5) Physical therapy, speech therapy, and occupational therapy when furnished or supervised by a licensed therapist and periodically reviewed by a physician or other licensed practitioner;

(6) Whole blood or packed red cells;

(7) Drugs and biologicals which cannot be self-administered;

(8) Dialysis treatments;

(9) Services of hospital-based physicians or other licensed practitioner;

(10) Outpatient surgical procedures, including those procedures covered under the provisions of chapter 67:16:28;

(11) Sterilizations authorized under § 67:16:02:09;

(12) Hyperbaric oxygen therapy if the requirements listed on the department's prior authorization website are met; and

(13) Cardiac rehabilitation - Phase II.