South Dakota Administrative Rules
Title 67 - Department of Social Services
Article 67:16 - Covered medical services
Chapter 67:16:29 - Medical equipment
Section 67:16:29:02 - Medical equipment covered
Current through Register Vol. 51, page 43, September 23, 2024
Covered medical equipment includes medical equipment, prosthetic devices, and medical supplies required to improve the functioning of a malformed body part or treatment of an illness or injury that are listed on the department's fee schedule website and prescribed by a physician or other licensed practitioner. The recipient's condition must meet the coverage criteria listed on the department's billing guidance website for the item to be covered. Items not specifically listed may not be covered by South Dakota Medicaid. Documentation substantiating the recipient's condition must be on file with the provider. Items requiring prior authorization are listed on the department's prior authorization website.
Supplies necessary for the effective use or proper functioning of covered medical equipment are covered when:
(1) The equipment is covered by Medicaid;
(2) The recipient's condition meets the coverage criteria for equipment; and
(3) The equipment is owned by the recipient.
Supplies for rented durable medical equipment are included in the Medicaid rental payment, unless specifically listed on the department's billing guidance website.
In addition to the specific limits established in this chapter, replacement of medical equipment is allowed only when a medical condition exists which necessitates the replacement of the particular piece of equipment. The prescribing physician or other licensed practitioner must determine whether a medical necessity exists and must document the need on the prescription for the replacement equipment.
Non-covered items may be requested by the recipient's physician or other licensed practitioner. Requests for non-covered items must demonstrate medical necessity and be prior authorized by the department.
General Authority: SDCL 28-6-1.
Law Implemented: SDCL 28-6-1(1)(2).
Limits on the provision of medical equipment and supplies, § 67:16:29:04.
