A claim submitted under this chapter for covered implantable contraceptive capsules and obstetrical services must be submitted at the provider's usual and customary charge and is limited to the nonlaboratory procedure codes listed in the applicable fee schedule pursuant to § 67:16:02:01.01.

A claim submitted for insertion or reinsertion, implantable contraceptive capsule may not include the cost of the kit. The kit must be billed separately.

Providers must use the appropriate current procedural terminology code to indicate obstetric care, antepartum care, delivery, and postpartum care. When applicable, providers shall bill using the global delivery codes defined on the department's billing guidance website. A provider may not separate claims for antepartum care, delivery services, or postpartum care when using a global delivery code.

A claim submitted for postpartum care is limited to hospital and office visits in the sixty days following vaginal or cesarean section delivery.

Definitions, "Webiste" (FeeScheduleWebsite), subdivision 67:16:01:01(18).

Source: 20 SDR 28, effective August 31, 1993; 20 SDR 149, effective March 21, 1994; 21 SDR 183, effective April 30, 1995; 23 SDR 38, effective September 26, 1996; 34 SDR 68, effective September 12, 2007; 42 SDR 51, effective October 13, 2015 ; 43 SDR 80, effective December 5, 2016; 52 SDR 126, effective July 1, 2026 .

General Authority: SDCL 28-6-1 .

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

Prior versions effective: 2016-12-05, 2015-10-13, 2007-09-12.