South Dakota Medicaid provided a number of temporary coverage flexibilities during the COVID-19 Public Health Emergency (PHE). The federal PHE is ending May 11, 2023.
South Dakota Medicaid is making the following temporary telemedicine coverage permanent as of May 11, 2023:
- Speech and Language Pathology
- ABA Therapy Services
- Physical Therapy
- Occupational Therapy
- Audiology Services
- Physical and Occupational Therapy in provided by school districts
South Dakota Medicaid is ending the following temporary coverage effective May 11, 2023:
| Coverage | Change | Expiration Date |
| Well Child Check-ups | Telemedicine coverage will no longer be available. Well child checkups should be performed in person. |
05/11/2023 |
| Medicare Alignment | South Dakota Medicaid will align with Medicaid and end telemedicine coverage of the following codes no longer covered by Medicare via telemedicine:
92065, 92584, 92605, 92606, 92618, 96110, 96127, 96161, 99217, 99218, 99219, 99220, 99224, 99225, 99226, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99343, 99453, 99454, 99457, and 99458 |
05/11/2023 |
| Remote Patient Monitoring | The following remote patient monitoring codes will no longer be covered: 99453, 99454, 99457, and 99458 |
05/11/2023 |
| Originating Site Fee | Providers may no longer bill the originating site fee for a recipient’s home as a “hospital location” known to and approved by Medicare. |
05/11/2023 |
| Transportation Services: Ground Ambulance Services | Providers will no longer be reimbursed for ground ambulance transportation from a hospital with a higher level of care to a hospital with a lower level of care to accommodate the care of additional recipients with a COVID-19 diagnosis. |
05/11/2023 |
In addition to the services listed above, the following coverages are set to expire at a later date:
| Coverage | Change |
Expiration Date |
| Cost Sharing | Cost-sharing for testing services (including in vitro diagnostic products), testing related services, treatments for COVID-19, and specialized equipment and therapies (including drugs) will continue to be exempt until the expiration date. At the expiration date, applicable cost sharing will resume.
Cost sharing for COVID-19 vaccines, administration and vaccine counseling will be exempt from cost share on a permanent basis. |
09/30/2024 |
| PREP Act | Current coverage for pharmacist administered claims for recipients aged 3 years old or older without a physician or other licensed practitioner’s order will no longer be allowed after the expiration date.
Podiatrists will no longer be reimbursed for administering COVID-19 vaccines after the expiration date. |
Provider Manuals will be updated to reflect changes in coverages and may be found on the South Dakota Medicaid webpage.
