South Dakota Administrative Rules
Title 67 - Department of Social Services
Article 67:16 - Covered medical services
Chapter 67:16:07 - Podiatric services
Section 67:16:07:05 - Rate of payment

A claim submitted under this chapter must be submitted at the podiatrist's usual and customary charge. Except for bilateral or multiple surgeries, payment is limited to the lesser of the provider's usual and customary charge or the fee contained on the department's website. If no fee is listed, payment is limited to 40 percent of the provider's usual and customary charge. The maximum rate of payment for covered podiatry services is available on the department's fee schedule website.

If a provider performs bilateral or multiple surgeries during the same operating session, the department follows the payment methodology established in chapter 67:16:02.

A provider may request that the rate of payment be amended. The request must be in writing and directed to the department's state Medicaid director. The provider must specify the reason for the requested change. The department shall review the request and determine whether the rate change is warranted and there is sufficient revenue to cover the increase. When the department takes final action on the requested change, the department shall notify the podiatrist who requested the change. A change in a payment rate is reflected on the department's fee schedule website.

General Authority: SDCL 28-6-1(1)(2).

Law Implemented: SDCL 28-6-1, 28-6-1.1.