Terms used in this section mean:

1. (1) "ASC Z12N standard format," the standards for electronic data interchange within the health care industry developed by the Accredited Standards Committee Z12N Insurance Subcommittee of the American National Standards Institute;
2. (2) "CDT-2 codes," the current dental terminology prescribed by the American Dental Association;
3. (3) "CPT-4 codes," codes for medical services and procedures performed by medical providers as listed in Physicians Current Procedural Terminology, (CPT '95) Fourth Edition, published by the American Medical Association;
4. (4) "HCFA," the Health Care Financing Administration of the U.S. Department of Health and Human Services;
5. (5) "HCFA Form 1450," the health insurance claim form maintained by HCFA for use by institutional care practitioners;
6. (6) "HCFA Form 1500," the health insurance claim form maintained by HCFA for use by health care practitioners;
7. (7) "HCPCS," HCFA's common procedure coding system which describes products, supplies, procedures, and health professional services;
8. (8) "HCPCS Level 1 Codes," the AMA's CPT-4 codes and modifiers for professional services and procedures;
9. (9) "HCPCS Level 2 Codes," alphanumeric codes and modifiers for health care products and supplies, as well as some codes for professional services not included in the AMA's CPT-4;
10. (10) "HCPCS Level 3 Codes," local alphanumeric codes and modifiers for items and services not included in the HCPCS Level 1 or HCPCS Level 2;

11. (11) "Health care practitioner," a provider of health care as follows:

    1. (a) A chiropractor licensed under SDCL chapter 36-5;
    2. (b) A corporation or partnership of health care practitioners listed in this subdivision;
    3. (c) A dentist licensed under SDCL chapter 36-6A;
    4. (d) A nurse licensed under SDCL chapter 36-9 or 36-9A;
    5. (e) An optometrist licensed under SDCL chapter 36-7;
    6. (f) A physician licensed under SDCL chapter 36-4;
    7. (g) A podiatrist licensed under SDCL chapter 36-8;
    8. (h) A psychologist licensed under SDCL chapter 36-27A;
    9. (i) A speech, physical, respiratory, or occupational therapist licensed under SDCL chapter 36-10 or 36-31;
    10. (j) A medical assistant licensed under SDCL chapter 36-9B;
    11. (k) A physician assistant licensed under SDCL chapter 36-4A; or
    12. (l) An emergency medical technician licensed under SDCL chapter 36-4B;
12. (12) "ICD-9-CM codes," the diagnosis and procedure codes in the International Classification of Diseases, Ninth Revision, Clinical Modification published by the U.S. Department of Health and Human Services;
13. (13) "Institutional care practitioner," a facility licensed under SDCL chapter 34-12 or listed in § 44:04:01:02;
14. (14) "Issuer," an insurance company, fraternal benefit society, health care service plan, health maintenance organization, third party administrator, and any other entity reimbursing the costs of health care expenses;
15. (15) "J512 form," the uniform dental claim form approved by the American Dental Association for use by dentists;
16. (16) "Revenue codes," the codes established for use by institutional care practitioners by the National Uniform Billing Committee.

Source: 22 SDR 97, effective December 18, 1995.

General Authority: SDCL 58-12-14.

Law Implemented: SDCL 58-12-12.