Covered medical equipment includes medical equipment, prosthetic devices, and medical supplies required to improve the functioning of a malformed body part or treatment of an illness or injury, which are listed on the department's fee schedule website and prescribed by a physician or other licensed practitioner. The recipient's condition must meet the coverage criteria listed on the department's billing guidance website for the item to be covered. Items not listed may not be covered by South Dakota Medicaid. Documentation substantiating the recipient's condition must be on file with the provider. Items requiring prior authorization are listed on the department's prior authorization website.

1. (1) The equipment is covered by Medicaid;
2. (2) The recipient's condition meets the coverage criteria for equipment; and

3. (3) The equipment is owned by the recipient.

   Supplies for rented durable medical equipment are included in the Medicaid rental payment, unless specifically listed on the department's billing guidance website.

   In addition to the specific limits established in this chapter, replacement of medical equipment is allowed only when a medical condition exists which necessitates the replacement of the particular piece of equipment. The prescribing physician or other licensed practitioner must determine whether a medical necessity exists and must document the need on the prescription for the replacement equipment.

   Non-covered items may be requested by the recipient's physician or other licensed practitioner. Requests for non-covered items must demonstrate medical necessity and be prior authorized by the department.

Supplies necessary for the effective use or proper functioning of covered medical equipment are covered when:

Source: 9 SDR 164, effective June 30, 1983; 12 SDR 70, effective October 31, 1985; transferred from § 67:16:02:12, 14 SDR 46, effective September 28, 1987; 16 SDR 239, effective July 9, 1990; 17 SDR 194, effective July 1, 1991; 18 SDR 210, effective June 23, 1992; 22 SDR 138, effective May 2, 1996; 24 SDR 11, effective August 4, 1997; 25 SDR 18, effective August 18, 1998; 29 SDR 116, effective February 23, 2003; 35 SDR 88, effective October 23, 2008; 44 SDR 94, effective December 4, 2017; 47 SDR 38, effective October 6, 2020.

General Authority: SDCL 28-6-1.

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

Prior versions effective: 2017-12-04, 2008-10-23.