Claims for medical equipment must be submitted at the provider's usual and customary charge. If it is the provider's custom to charge the general public for handling, delivery, and taxes, those charges may be included in the provider's usual and customary charge. A provider may not bill the department for equipment until the equipment has been delivered to the recipient.

The department may require a copy of the physician's or other licensed practitioner's written prescription, the invoice showing the purchase price of the equipment, and other documentation be submitted with the claim. If documentation is submitted, the provider must maintain the documents in the recipient's medical record and make the documents available upon request.

Covered equipment is billed using the applicable procedure code.

A provider may not submit claims that do not meet the criteria contained in this chapter.

A provider may not submit a claim for hearing aids until after thirty days of placement. A provider may not submit a claim if the hearing aids are returned during a trial period.

Claim requirements, § 67:16:29:11.

Source: 16 SDR 239, effective July 9, 1990; 17 SDR 194, effective July 1, 1991; 18 SDR 210, effective June 23, 1992; 19 SDR 26, effective August 23, 1992; 24 SDR 11, effective August 4, 1997; 29 SDR 116, effective February 23, 2003; 34 SDR 68, effective September 12, 2007; 35 SDR 49, effective September 10, 2008; 42 SDR 51, effective October 13, 2015 ; 44 SDR 94, effective December 4, 2017 ; 47 SDR 38, effective October 6, 2020 ; 50 SDR 63, effective November 27, 2023; 52 SDR 126, effective July 1, 2026 .

General Authority: SDCL 28-6-1 .

Law Implemented: SDCL 28-6-1 .

Prior versions effective: 2023-11-27, 2020-10-06, 2017-12-04, 2015-10-13, 2008-09-10.