A claim submitted for community transportation services must be at the provider's usual and customary charge. A provider may not submit a claim for loaded mileage if the trip is 20 miles or less.

A claim for community transportation services must contain the applicable procedure codes for the services provided. If an extra patient is transported with the recipient, the provider must add the modifier "TK" to the procedure code being billed. If the trip is outside the provider's customary service area, the provider must add the modifier "TN" to the procedure code being billed.

A long-term care facility may not submit a claim for community transportation services. Such services are considered routine under the provisions of § 67:16:04:41 and are included in the facility's cost reports required in § 67:16:04:34.

Source: 22 SDR 20, effective August 24, 1995; 35 SDR 253, effective May 12, 2009; 44 SDR 94, effective December 4, 2017.

General Authority: SDCL 28-6-1 (1)(2)(4) .

Law Implemented: SDCL 28-6-1 (1)(2)(4) .

Prior versions effective: 2009-05-12.