A claim submitted under this chapter must be submitted at the provider's usual and customary charge. Payment is limited to the lesser of the provider's usual and customary charge or the amount specified on the department's fee schedule website.

The rates of payment are subject to review and amendment by the department. A provider may request that the department review a particular reimbursement rate for possible adjustment or request the inclusion or exclusion of a particular code from the list. When reviewing the requests, the department shall review paid claims information, Medicare fee schedules, national coding lists, and documentation submitted by the provider or the associated medical professional organization to determine whether a change is warranted.

Source: SL 1975, ch 16, § 1; 1 SDR 30, effective October 13, 1974; 7 SDR 66, 7 SDR 89, effective July 1, 1981; 11 SDR 86, effective December 30, 1984; 13 SDR 141, effective April 5, 1987; 15 SDR 2, effective July 17, 1988; 16 SDR 64, effective October 8, 1989; 16 SDR 235, effective July 5, 1990; 17 SDR 200, effective July 1, 1991; 20 SDR 49, effective October 14, 1993; 20 SDR 135, effective February 22, 1994; 20 SDR 159, effective April 6, 1994; 21 SDR 68, effective October 13, 1994; 22 SDR 94, effective January 10, 1996; 24 SDR 86, effective January 1, 1998; 26 SDR 157, effective June 7, 2000; 35 SDR 49, effective September 10, 2008; 42 SDR 51, effective October 13, 2015.

General Authority: SDCL 28-6-1(2) , 28-6-1.1.

Law Implemented: SDCL 28-6-1(2) , 28-6-1.1.

Prior versions effective: 2008-09-10.