67:16:03:06.18. Basis of reimbursement -- Outpatient prospective payment system. Medicare prospective payment system hospitals and out-of-state hospitals must be paid using the department's outpatient prospective payment system (OPPS). Under the OPPS, services are reimbursed using ambulatory payment classifications. The conversion factor, weights, and fee schedule rates for services not assigned an ambulatory payment classification are published on the department's fee schedule website.

Outpatient prospective payments may not include any item or service for which payment may be made under other provisions of this article, unless the item or service is specifically included on the department's fee schedule website.

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

Source: 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.