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.


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


Remote Patient Monitoring The following remote patient monitoring codes will no longer be covered: 99453, 99454, 99457, and 99458


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.


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.


In addition to the services listed above, the following coverages are set to expire at a later date:


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.

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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