HomeLatest NewsCovid-19Changes to Medicaid Coverage with PHE Ending

Changes to Medicaid Coverage with PHE Ending

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.

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