S.D. Admin. R. 67:16:08:06
A claim submitted under this chapter must be submitted at the provider's usual and customary charge. Payment is limited to the lesser of the provider's usual and customary charge or the amount specified on the department's fee schedule website.
The rates of payment are subject to review and amendment by the department. A provider may request that the department review a particular reimbursement rate for possible adjustment or request the inclusion or exclusion of a particular code from the list. When reviewing the requests, the department shall review paid claims information, Medicare fee schedules, national coding lists, and documentation submitted by the provider or the associated medical professional organization to determine whether a change is warranted.
S.D. Admin. R. 67:16:08:06
General Authority: SDCL 28-6-1(2), 28-6-1.1.
Law Implemented: SDCL 28-6-1(2), 28-6-1.1.