Last updated 03/03/2023
Email, Phone & Fax
Telephones, facsimile machines, and electronic mail systems do not meet the definition of an interactive telecommunications system.
Audio-Only Modifier
- CMHC and SUD Agencies: Bill modifier GT in addition to the POS code 77.
- All other providers allowed to bill audio only services: Bill modifier 93 in addition to the POS code 77.
SOURCE: SD Medicaid Billing and Policy Manual: Telemedicine, pgs. 11-12 (Sept. 2022) (Accessed Mar. 2023).
Audio-Only Behavioral Health Services
Effective August 22, 2021, South Dakota Medicaid covers real time, two-way audio-only behavioral health services delivered by a Substance Use Disorder (SUD) Agency or a Community Mental Health Center (CMHC) when the recipient does not have access to face-to-face audio/visual telemedicine technology.
Effective October 3, 2021, South Dakota Medicaid covers real-time, two-way audio-only behavioral health services delivered by an Independent Mental Health Practitioner (IMHP) when the recipient does not have access to face-to-face audio/visual telemedicine technology.
SUD agencies and CMHCs, and IMHPs must utilize traditional audio/visual telemedicine technology when possible. Audio-only services are not covered when used for the convenience of the provider or recipient. The provider must document in the medical record that the use real time video/audio technology was not possible or was unsuccessful.
SOURCE: SD Medicaid Billing and Policy Manual: Telemedicine, p. 4 (Sept. 2022) (Accessed Mar. 2023).
Telephonic Evaluation and Management Services
Audio-only evaluation and management services are covered for established patients if the recipient does not have access to face-to-face audio/visual telemedicine technology. The provider must document in the medical record that the use real time video/audio technology was not possible or was unsuccessful.
The service must be initiated by the patient. The service should include patient history and/or assessment, and some degree of decision making. Telephonic evaluation and management services are only allowed to be provided by a physician, podiatrist, nurse practitioner, physician assistant, or optometrist. The service must be 5 minutes or longer. Services may be provided via telephone or via another device or service that allows real-time audio communication.
Audio-only evaluation and management services are not to be billed if clinical decision-making dictates a need to see the patient for an office visit, including a telemedicine office visit, within 24 hours or at the next available appointment time. In those circumstances, the telephone service is considered a part of the subsequent office visit. If the telephone call follows a billable office visit performed in the past seven calendar days for the same or a related diagnosis, then the telephone services are considered part of the previous office visit and are not separately billable. Telephone services provided by an RN or LPN are not billable. See manual for other conditions and requirements.
CMHCs may provide all covered services via audio-only technology when coverage requirements are met. SUD agencies may only provide covered SUD agency services listed in the Audio-Only Procedure Code table in Appendix via audio-only technology when the coverage requirements are met. Contact the Division of Behavioral Health for questions regarding unlisted codes.
For FQHCs/RHCs and IHS/Tribal 638 Providers, SUD agency services may also be provided via audio-only if the provider is an accredited and enrolled agency. Audio-only behavioral health services are reimbursed at the encounter rate.
Services other than those specifically stated as covered when provided via an audio-only modality are considered non-covered if provided via an audio-only modality and must not be billed to South Dakota Medicaid.
SOURCE: SD Medicaid Billing and Policy Manual: Telemedicine, p. 5 (Sept. 2022), (Accessed Mar. 2023).
Crisis assessment and intervention services are covered which includes an immediate therapeutic response available 24 hours a day 7 days a week that involves direct telephone or face-to-face contact with a recipient exhibiting acute psychiatric symptoms and/or inappropriate behavior that left untreated, presents an immediate threat to the recipient or others.
SOURCE: SD Medicaid Billing and Policy Manual: Community Mental Health Center Services, p. 5 (Sept. 2022), (Accessed Mar. 2023).
Collateral contacts is covered which involves telephone or face-to-face contact with an individual other than the identified recipient to plan appropriate treatment, assist others so they can respond therapeutically regarding the recipient’s difficulty or illness, or link the recipient, family, or both, to other necessary and therapeutic community support.
SOURCE: SD Medicaid Billing and Policy Manual: Community Mental Health Center Services, p. 8 (Sept. 2022) & Substance Use Disorder Agency Services, p. 6-7 (Sept.. 2022) (Accessed Mar. 2023).
SD Medicaid does not cover physician telephone patient services, online medical evaluation, interprofessional telephone/internet/electronic health record consultations (CPT codes 99441-99443, 99444, 99446- 99449 and 99451-99452).
SOURCE: SD Medicaid Billing and Policy Manual: Physician Services, p. 11 (Feb. 2023), (Accessed Mar. 2023).
Teledentistry
Synchronous teledentistry services may not be provided via email, audio-only, or facsimile transmissions.
SOURCE: SD Medicaid Billing and Policy Manual, Teledentistry Services, p. 3, (Sept. 2022), (Accessed Mar. 2023).
Last updated 03/03/2023
Live Video
POLICY
Services provided via telemedicine are subject to the same service requirements and limitations as in-person services.
These coverage requirements apply for telemedicine services in SD Medicaid:
- The provider must be properly enrolled;
- Services must be medically necessary;
- The recipient must be eligible; and
- If applicable, the service must be prior authorized.
The manual also includes non-discrimination requirements providers must abide by.
Providers must bill for services at their usual and customary charge. Providers are reimbursed the lesser of their usual and customary charge or the fee schedule rate. Reimbursement for distant site telemedicine services is limited to the individual practitioner’s professional fees or the encounter rate if the service qualifies as an FQHC/RHC or IHS/Tribal 638 clinic service. The maximum allowable amount for services provided via telemedicine is the same as services provided in-person.
See Appendix of manual for complete list of CPT codes, but please note that current version of this manual includes services that are only being covered on a temporary basis.
SOURCE: SD Medicaid Billing and Policy Manual: Telemedicine, p. 3, 11 & 13 (Sept. 2022) (Accessed Feb. 2023).
ELIGIBLE SERVICES/SPECIALTIES
See manuals for specific CPT codes in Appendix. Services not specifically listed as covered in the procedure code table in the Appendix are considered non-covered.
SOURCE: SD Medicaid Billing and Policy Manual: Telemedicine, p. 8, 13-22 (Sept. 2022) (Accessed Feb. 2023).
Community health worker services can be provided via telemedicine.
CHW Services must be related to a medical intervention outlined in the individual’s care plan. Service may be provided face-to-face, via telemedicine, or via two-way audio-only when the recipient does not have access to audio/visual telemedicine technology. The limitation necessitating audio-only services must be documented in the recipient’s record. Up to five (5) units of individual services may be performed in a clinic setting in a plan year to allow for the initial establishment of CHW/recipient relationship after which services are only allowed to be provided in a home or community setting. A CHW may attend medical appointments with a recipient. Group services may take place in a meeting
room of a medical setting. The care plan must be finalized prior to CHW services being rendered.
Covered services include:
- Health system navigation and resource coordination including helping a recipient find Medicaid providers to receive a covered service, helping a recipient make an appointment for a Medicaid covered service, arranging transportation to a medical appointment, attending an appointment with the recipient for a covered medical service, and helping a recipient find other relevant community resources such as support groups. In order to attend an appointment with a recipient the CHW must have written consent from the recipient.
- Health promotion and coaching including providing information or education to recipients that makes positive contributions to their health status such as cessation of tobacco use, reduction in the misuse of alcohol or drugs, improvement in nutrition, improvement of physical fitness, family planning, control of stress, pregnancy and infant care including prevention of fetal alcohol syndrome.
- Health education to teach or promote methods and measures that have been proven effective in avoiding illness and/or lessening its effects such as immunizations, control of high blood pressure, control of sexually transmittable disease, prevention and control of diabetes, control of toxic agents, occupational safety and health, and accident prevention. The content of the education must be consistent with established or recognized healthcare standards. Services may be provided to the parent or legal guardian of a recipient 18 or younger if the service is for the direct benefit of the recipient, in accordance with the recipient’s needs and care plan objectives, and for the purpose of addressing the diagnosis identified in the care plan.
SOURCE: SD Medicaid Billing and Policy Manual: Community Health Worker, pg. 4, (Feb. 2023). (Accessed Mar. 2023).
Speech language pathologist services can be provided via telemedicine if it meets the requirements in the in the Telemedicine manual.
SOURCE: SD Medicaid Billing and Policy Manual: Birth to Three Non-School District Providers, p. 3, (Sept. 2022), & Therapy Services pg. 4 (Aug. 2022). (Accessed Mar. 2023)
Select therapy services are temporarily allowed to be provided via telemedicine during the COVID-19 public health emergency. Refer to the Telemedicine manual regarding therapy services that may be provided via telemedicine.
SOURCE: SD Medicaid and Policy Manual: Therapy Services pg. 4 (Dec. 2022)., (Accessed Mar. 2023).
Select telemedicine services are temporarily being allowed to be provided by school districts during the COVID-19 public health emergency. Refer to the Telemedicine manual regarding speech language pathology, occupational therapy, physical therapy, and psychology services that may be provided via telemedicine.
SOURCE: SD Medicaid and Policy Manual: School Districts, pg. 4, (Sept. 2022), (Accessed Mar. 2023).
Psychotherapy is allowed to be provided via telehealth.
SOURCE: SD Medicaid Billing and Policy Manual: Independent Mental Health Practitioners, pg. 14, (Sept. 2022), (Accessed Mar. 2023).
An encounter for the initial ordering of durable medical equipment may occur through telehealth.
SOURCE: SD Medicaid Billing and Policy Manual: Durable Medical Equipment, Prosthetics, Orthotics and Supplies, pg. 2. Feb. 2023. (Accessed Mar. 2023).
Speech therapy services may be provided via telemedicine after an initial face-to-face contact and once every 90 days thereafter.
SOURCE: SD Medicaid Billing and Policy Manual: Telemedicine, p. 4 (Sept. 2022). (Accessed Mar. 2023).
A face-to-face encounter for physician recertification for hospice may occur via telemedicine.
SOURCE: SD Medicaid Billing and Policy Manual: Hospice, p. 2 (Sept. 2022), (Accessed Mar. 2023).
Telemedicine consultations are covered as outpatient hospital services.
SOURCE: SD Medicaid Billing and Policy Manual: Outpatient Hospital Services, p. 2 (Feb. 2023), (Accessed Mar. 2023).
Applied Behavior Analysis
South Dakota Medicaid has added temporary coverage of ABA services provided via telemedicine for recipients and providers at high risk for COVID-19, under quarantine, or social distancing during a declared emergency for COVID-19.
SOURCE: SD Medicaid Billing and Policy Manual: Applied Behavior Analysis, p. 7 (Sept. 2022). (Accessed Mar. 2023).
Therapy Services
South Dakota Medicaid has added temporary coverage of therapy services provided via telemedicine for recipients and providers at a high risk for COVID-19, under quarantine, or social distancing during a declared emergency for COVID-19, only if the recipient and provider have previously met for in-person services.
SOURCE: SD Medicaid Billing and Policy Manual: Therapy Services, p. 8 (Dec. 2022). (Accessed Mar. 2023).
Teledentistry
Services provided via teledentistry must meet the applicable standard of care. When reporting a service completed via teledentistry, providers are certifying the services rendered to the recipient were functionally equivalent to services provided through a face-to-face visit. Services provided via teledentistry must be provided in accordance with the coverage criteria in the adult and children dental provider manuals. Synchronistic services must be of sufficient audio and visual fidelity and clarity to be functionally equivalent to a face-to-face encounter.
See manual for list of codes.
SOURCE: SD Medicaid Billing and Policy Manual, Teledentistry Services, p. 2, (Sept. 2022), (Accessed Mar. 2023).
Home Health
For the initial order for home health services, a physician or other licensed practitioner must document a face-to-face encounter related to the primary reason the beneficiary requires the services. The encounter may occur through telemedicine. The encounter must occur within the 90 days before or 30 days after the start of the services.
SOURCE: SD Medicaid Billing and Policy Manual: Home Health Agency Services, p. 2 (Jan. 2023). (Accessed Mar. 2023).
Physician Administered Drugs – Pediatric Vaccination Counseling
A total of six counseling sessions (three for each code) per recipient, per calendar, year are reimbursable. Counseling may be provided via telemedicine. Counseling may also be provided via audio only if the visit was initiated by the recipient and the recipient does not have access to face-toface audio/visual telemedicine technology. Telemedicine and audio only services must be billed in accordance with the Telemedicine Services billing manual.
SOURCE: SD Medicaid Billing and Policy Manual: Physician Administered Drugs, p. 23 (Dec. 2022). (Accessed Mar. 2023).
ELIGIBLE PROVIDERS
The following providers can provide services via telemedicine at a distant site:
- Certified Social Worker (PIP or PIP Candidate)
- Clinical Nurse Specialist
- Community Health Worker
- Community Mental Health Centers (CMHC)
- Dentists
- Diabetes Education Programs
- Dietitians
- Federally Qualified Health Centers (FQHC)
- Indian Health Services Clinics
- Licensed Marriage and Family Therapists
- Licensed Professional Counselor (MH or working toward MH designation)
- Nurse Practitioners
- Nutritionists
- Physicians
- Physician Assistants
- Podiatrists
- Psychologist
- Rural Health Clinic (RHC)
- Speech Language Pathologists
- Substance Use Disorder Agencies
- Tribal 638 facilities
* Audiologists, occupational therapists, physical therapists and optometrists are listed as temporarily allowed during COVID-19 PHE in the provider manual, but are not permanent eligible providers.
Unless prohibited by law or regulation the distant site location may be a provider’s home. South Dakota Medicaid does not require the distant site location be listed on their provider enrollment record. All services provided via telemedicine at a distant site must be billed with the GT modifier in the first modifier position to indicate the service was provided via telemedicine.
SOURCE: SD Medicaid Billing and Policy Manual: Telemedicine, p. 1 – 4 (Sept. 2022). (Accessed Mar. 2023).
Speech therapy services may be provided via telemedicine once an initial in-person contact has been completed. An in-person contact must occur every 90 days thereafter. The telemedicine service must be provided by means of “real-time” interactive telecommunications system.
SOURCE: SD Medicaid Billing and Policy Manual: Therapy Services, pg. 8, (Dec. 2022), (Accessed Mar. 2023).
Indian Health Services and Tribal 638 Providers
IHS clinics are eligible to serve as an originating site for telemedicine services. IHS/Tribal 638s may also provide distant site telemedicine services. A distant site is the physical location of the practitioner providing the service via telemedicine. In order to bill an encounter, the practitioner or recipient should be located at the IHS/Tribal 638 clinic. As a temporary exception during the COVID-19 Public Health Emergency, home-to-home telemedicine services are permitted. Please refer to the Telemedicine Manual for additional information.
IHS is eligible to serve as an originating site for telemedicine services and may also provide distant site telemedicine services.
- An originating site is the physical location of the Medicaid recipient at the time the service is provided.
- A distant site is the physical location of the practitioner providing the service via telemedicine.
Please refer to the Telemedicine manual for additional information.
“Encounter,” a face-to-face or telemedicine contact between a health care professional and a Medicaid recipient for the provision of Medicaid or CHIP services through an IHS or Tribal 638 facility within a 24-hour period ending at midnight.
SOURCE: SD Medicaid Billing and Policy Manual: IHS and Tribal 638 Providers, p. 5 & 12 & 15, (Feb. 2023), (Accessed Mar. 2023).
FQHC/RHCs are eligible to serve as an originating site for telemedicine services and may also provide distant site telemedicine services. An originating site is the physical location of the Medicaid recipient at the time the service is provided. A distant site is the physical location of the practitioner providing the service via telemedicine. Please refer to the Telemedicine manual for additional information.
SOURCE: SD Medicaid Billing and Policy Manual: FQHC and RHC Services, pg. 7, (Nov. 2022) (Accessed Mar. 2023).
ELIGIBLE SITES
Effective July 1, 2021, South Dakota Medicaid removed the same community restrictions for telemedicine services. Previously if a provider and recipient were both located in the same community, services were not covered via telemedicine unless one of the stated exceptions was met. The decision of whether it is appropriate to deliver the service via telemedicine should be determined by the provider and the recipient.
Originating sites listed in the eligible provider section are eligible to receive a facility fee for each completed telemedicine transaction for a covered distant site telemedicine service. Sites not listed may also serve as an originating site but are not eligible for a facility fee reimbursement. Originating site are not reimbursed for any additional costs associated with equipment, technicians, technology, or personnel utilized in the performance of the telemedicine service. Originating sites must be enrolled with South Dakota Medicaid.
A home can be an originating site but is not eligible for reimbursement of the originating site fee.
For distant site services billed on a CMS 1500 or 837P providers must bill;
- “02” for telemedicine services provided other than in patient’s home;
- “10” for telemedicine services provided in the patient’s home; or
- “77” for audio-only services.
SOURCE: SD Medicaid Billing and Policy Manual: Telemedicine, p. 1, 3 & 11 (Sept. 2022). (Accessed Mar. 2023).
FQHC/RHCs are eligible to serve as an originating site for telemedicine services and may also provide distant site telemedicine services. An originating site is the physical location of the Medicaid recipient at the time the service is provided.
Reimbursement for the telemedicine facility fee is limited to the amount listed on the Physician Services fee schedule.
A claim for a telemedicine originating site fee should be billed under the FQHC/RHC’s NPI. As indicated above, payment is limited to the fee schedule amount.
SOURCE: SD Medicaid Billing and Policy Manual: FQHC and RHC Services, pg. 7, 8, 10, (Nov. 2022) (Accessed Feb. 2023).
Indian Health Services and Tribal 638 Providers
IHS clinics are eligible to serve as an originating site for telemedicine services. IHS/Tribal 638s may also provide distant site telemedicine services. An originating site is the physical location of the Medicaid recipient at the time the service is provided.
IHS is eligible to serve as an originating site for telemedicine services and may also provide distant site telemedicine services.
- An originating site is the physical location of the Medicaid recipient at the time the service is provided.
- A distant site is the physical location of the practitioner providing the service via telemedicine.
Please refer to the Telemedicine manual for additional information.
If IHS is an originating site for a telemedicine service, the originating site fee should be billed on the applicable claim form for the service. For services billed on a CMS 1500 or 837P, IHS should bill for the originating site fee using HCPCS code Q3014.
SOURCE: SD Medicaid Billing and Policy Manual: IHS and Tribal 638 Providers, p. 5, 12 (Feb. 2023), (Accessed Mar. 2023).
GEOGRAPHIC LIMITS
Effective July 1, 2021, South Dakota Medicaid removed the same community restrictions for telemedicine services. Previously if a provider and recipient were both located in the same community, services were not covered via telemedicine unless one of the stated exceptions was met. The decision of whether it is appropriate to deliver the service via telemedicine should be determined by the provider and the recipient.
SOURCE: SD Medicaid Billing and Policy Manual: Telemedicine, p. 3 (Sept. 2022), (Accessed Mar. 2023).
FACILITY/TRANSMISSION FEE
Certain originating sites are eligible for a facility fee and are:
- Office of a physician or practitioner
- Outpatient Hospital
- Critical Access Hospital
- Rural Health Clinic
- Federally Qualified Health Center
- Indian Health Services Clinic
- Community Mental Health Center
- Substance use disorder agency
- Nursing Facilities
- Schools
Originating site are not reimbursed for any additional costs associated with equipment, technicians, technology, or personnel utilized in the performance of the telemedicine service. A recipient’s home is not eligible for reimbursement of an originating site facility fee. For group services with multiple recipients in the same originating site location, only one originating site fee is billable per physical location of the recipients. For Division of Behavioral Health block grant contract providers, the originating site fee should only be billed to Medicaid if the group includes both Medicaid recipients and individuals ineligible for Medicaid. The originating site fee is not reimbursable for audio-only services and should not be billed for these services. An originating site fee also is not reimbursable if the service could be provided onsite at the originating site, but the service is being provided via telemedicine solely due to patient preference to see a provider that is not located at the originating site.
SOURCE: SD Medicaid Billing and Policy Manual: Telemedicine, p. 2-3; 9, 11. (Sept. 2022). (Accessed Mar. 2023).
Skilled Nursing Facility and Nursing Facility Services
The telemedicine originating site fee is reimbursed at the lesser of the provider’s usual and customary charge and the fee for HCPCS code Q3014 listed on the Physician Services Fee Schedule. The telemedicine originating site fee must be billed using revenue code 780.
SOURCE: SD Medicaid Billing and Policy Manual: Skilled Nursing Facility and Nursing Facility Services, p. 10, (Jul. 2022), (Accessed Mar. 2023).
Teledentistry
An originating site is the physical location of the patient at the time a synchronous (live, two-way interaction between a patient and a provider using audiovisual telecommunications technology) teledentistry service is provided. A distant site is the physical location of the practitioner providing the service via synchronous teledentistry.
Enrolled dental providers, such as a dental office, FQHC/RHC, or IHS facility, are eligible to receive an originating site facility fee for acting as an originating site if the service being provided from the distant site is a covered teledentistry service. Other sites not listed may also serve as an originating site but are not eligible for an originating site facility fee reimbursement. Asynchronous services are not eligible for an originating site fee.
The maximum rate for originating site facility fee is listed on the physician fee schedule under procedure code Q3014. The facility fee is reimbursed on a fee for service basis for eligible encounter-based providers. There is no additional reimbursement for equipment, technicians, technology, or personnel utilized during services provided via teledentistry.
The originating site must submit a CMS 1500 or 837P claim to South Dakota Medicaid. For more information on originating sites please refer to the Telemedicine manual. Originating site are not reimbursed for any additional costs associated with equipment, technicians, technology, or personnel utilized in the performance of the teledentistry service. For more information on originating sites please refer to the Telemedicine manual.
SOURCE: SD Medicaid Billing and Policy Manual, Teledentistry Services, p. 5 &6, (Sept. 2022), (Accessed Mar. 2023).
FQHC/RHC
Reimbursement for the telemedicine facility fee is limited to the amount listed on the Physician Services fee schedule.
A claim for a telemedicine originating site fee should be billed under the FQHC/RHC’s NPI. As indicated above, payment is limited to the fee schedule amount.
SOURCE: SD Medicaid Billing and Policy Manual: FQHC and RHC Services, p. 8 & 10 (Nov. 2022). (Accessed Mar. 2023).
