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SD Medicaid Well-Child Reimbursements

South Dakota Medicaid is updating the well-child check-up reimbursement rates. The new rates move the services closer to the target rate. The rate changes are applicable for dates of service of December 1, 2019 or later. The table below lists the updated rates:

CPT Code Description Updated Rate
99381 New patient initial comprehensive preventative visit, infant $103.08
99382 New patient initial comprehensive preventative visit, age 1 through 4 $103.08
99383 New patient initial comprehensive preventative visit, age 5 through 11 $103.08
99384 New patient initial comprehensive preventative visit, age 12 through 17 $103.08
99385 New patient initial comprehensive preventative visit, age 18 to 39 $103.08
99391 Established patient initial comprehensive preventative visit, infant $70.18
99392 Established patient initial comprehensive preventative visit, age 1 through 4 $70.18
99393 Established patient initial comprehensive preventative visit, age 5 through 11 $70.18
99394 Established patient initial comprehensive preventative visit, age 12 through 17 $70.18
99395 Established patient initial comprehensive preventative visit, age 18 to 39 $70.18

As a reminder well-child check-ups should be provided in accordance with the State of South Dakota’s Well-Child Services manual. ​

 

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