A modifier code provides the means by which the reporting provider indicates on the claim form that a service that was provided was altered by some specific circumstance but not changed in its definition or code. When applicable, the following codes must be included on a provider's claim for ambulance, secure medical, or community transportation services:

Modifier Description

TK Extra patient

TN Rural/outside the provider's customary service area

QM Hospital arranged secure medical transfer.

Source: 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.