Last updated 08/01/2023
Email, Phone & Fax
Telephones, facsimile machines, and electronic mail systems do not meet the definition of an interactive telecommunications system.
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.
Telemedicine Modifiers – Telemedicine provided at a distant site must be billed with the GT modifier in the first modifier position to indicate the service was provided via telemedicine/audio-only. Failure to comply with this requirement may lead to payment recoupment or other action as decided by South Dakota Medicaid.
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. 9 & 10 (Jun. 2023) (Accessed Aug. 2023).
Audio-Only Behavioral Health Services
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.
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.
Covered Services – 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 the Appendix via audio-only technology when the coverage requirements are met. Contact the Division of Behavioral Health for questions regarding unlisted codes.
For the purpose of this manual, an IMHP includes mental health providers who meet the requirements in ARSD 67:16:41:03 and physicians that provide behavioral health services. IMHPs may provide applicable services listed in the Audio-Only Procedure Code table in the Appendix via audio-only technology when the coverage requirements are met. Services not listed in the table are not allowed to be provided via telemedicine or audio-only technology. An IMHP cannot bill the following CPT codes: 98966, 98967, and 98968.
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. Non-covered Services 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.
Claim Instructions – Audio-only services will need the GT modifier and place of service 77. Any additional modifiers must be coded alphabetically as shown on the CMHC and SUD fee schedules.
SOURCE: SD Medicaid Billing and Policy Manual: Telemedicine, p. 5-6 (Jun. 2023) (Accessed Aug. 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.
Claim Instructions – Services must be billed using CPT codes 98966, 98967, and 98968. Providers should select the appropriate code based on the time associated with the service. Do not bill for these services using CPT codes 99441, 99442, or 99443 even if you believe the code description is more applicable. Billing with 99441, 99442, or 99443 will result in your claim being denied.
Reimbursement – Payment for services is limited to the lesser of the provider’s usual and customary charge or the fee contained on South Dakota Medicaid’s Physician Services fee schedule. FQHC/RHC and IHS/Tribal 638 providers may bill for audio-only evaluation and management services using codes 98966, 98967, and 98968 and be reimbursed at the fee schedule rate. These services must be submitted using the FQHC/RHCs non-PPS billing NPI. For more information regarding billing with a non-PPS NPI please refer to the FQHC/RHC Service Manual.
Billing a Recipient – There is no cost share for this service. Please refer to our Billing a Recipient Manual for additional requirements a provider must meet to bill a recipient.
SOURCE: SD Medicaid Billing and Policy Manual: Telemedicine, p. 6-7 (Jun. 2023), (Accessed Aug. 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. 6 (Jun. 2023), (Accessed Aug. 2023).
Collateral Contacts are telephone or face-to-face contact with an individual other than the recipient receiving treatment in an outpatient setting. The contact may be with a spouse, family member,
guardian, friend, teacher, healthcare professional, or other individual who is knowledgeable of the recipient receiving treatment.
SOURCE: SD Medicaid Billing and Policy Manual: Community Mental Health Center Services, p. 8 (Jun. 2023) & Substance Use Disorder Agency Services, p. 7 (Jun. 2023) (Accessed Aug. 2023).
SD Medicaid does not cover: Anticoagulant management (CPT codes 93792 and 93793), physician telephone patient services (CPT codes 99441-99443), online medical evaluation (CPT code 99444), interprofessional telephone/internet/electronic health record consultations (CPT codes 99446-99449 and 99451-99452), remote monitoring (CPT codes 99091,99453, 99454, and 99457), disability evaluation services (CPT codes 99450, 99455, 99456), cognitive assessment and care plan services (CPT code 99483), care management services (CPT codes 99487-99496), and behavioral health integration care management (CPT code 99484).
SOURCE: SD Medicaid Billing and Policy Manual: Physician Services, p. 11 (Aug. 2023), (Accessed Aug. 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. 4, (Jun. 2023), (Accessed Aug. 2023).
Last updated 08/01/2023
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 listed on the applicable fee schedule. The maximum allowable amount for services provided via telemedicine is the same as services provided in-person. Facility related charges for distant site telemedicine providers are not reimbursable.
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. Services provided via teledentistry should include the following additional documentation in addition to the standard of service documentation:
- If synchronistic, the name of the platform used to complete the visit; and
- Detailed clinical notes of the visit including the name and credentials of individuals involved in the teledentistry visit and their role in the visit.
ELIGIBLE SERVICES/SPECIALTIES
Only certain procedure codes may be provided via telemedicine. Refer to the Appendix for a list of procedure codes allowed to be provided via telemedicine.
Services not specifically listed as covered in the procedure code table in the Appendix are considered non-covered. Claims submitted by a non-eligible originating site will be denied. Birth to Three services do not qualify for an originating site reimbursement unless provided at an eligible originating site location. Distant sites located outside of the United States are not covered.
SOURCE: SD Medicaid Billing and Policy Manual: Telemedicine, p. 4, 8, 12-20 (Jun. 2023) (Accessed Aug. 2023).
Applied Behavioral Analysis (ABA) Services – ABA services may be provided via telemedicine. The service must be provided by means of “real-time” interactive telecommunications system and the provider must have a face-to-face visit within the first 30 days and every 90 days thereafter. Please refer to the Applied Behavioral Analysis (ABA) Services manual for additional coverage information.
SOURCE: SD Medicaid Billing and Policy Manual: Telemedicine, p. 4 (Jun. 2023). (Accessed Aug. 2023).
Can ABA services be provided via telemedicine? Yes, South Dakota Medicaid allows ABA services to be provided via telemedicine. Refer to the Telemedicine manual for coverage details.
SOURCE: SD Medicaid Billing and Policy Manual: Applied Behavior Analysis, p. 7 (Apr. 2023). (Accessed Aug. 2023).
Audiology Services – Limited fitting and programming audiology services may be provided via telemedicine. The service must be provided by means of “real-time” interactive telecommunications system and the provider must have a face-to-face visit within the first 30 days and every 90 days thereafter. The following services may be performed when the patient is in any setting, including the patient’s home:
- Cochlear Implant Follow-Up/Reprogramming (CPT codes 92601-92604);
- Hearing Aid Checks (CPT codes 92592-92593), and
- Auditory Function Evaluation (CPT codes 92620, 92621, 92626, and 92627).
In addition, the following services can be provided via telemedicine when the patient is located in a clinic or other setting with a qualified health professional present:
- Tympanometry (CPT code 92550 and 92567); and
- Evoked Auditory Tests (CPT codes 92585-92588).
SOURCE: SD Medicaid Billing and Policy Manual: Telemedicine, p. 4 (Jun. 2023). (Accessed Aug. 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), (Accessed Aug. 2023).
Refer to the Telemedicine manual regarding therapy services that may be provided via telemedicine.
Can speech therapy be provided via telemedicine? Yes, 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.
Can therapy services be provided via telemedicine? Yes, refer to the Telemedicine manual regarding therapy services that may be provided via telemedicine.
SOURCE: Therapy Services pg. 4 & 8 (Jun. 2023). (Accessed Aug. 2023)
Teledentistry Services – Please refer to the Teledentistry Services manual for information regarding coverage of teledentistry services.
SOURCE: SD Medicaid Billing and Policy Manual: Telemedicine, p. 4 (Jun. 2023). (Accessed Aug. 2023).
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, (Jun. 2023), (Accessed Aug. 2023).
Therapy Services – Physical therapy, occupational therapy, and speech language therapy services may be provided via telemedicine. The service must be provided by means of “real-time” interactive telecommunications system and the provider must have a face-to-face visit within the first 30 days and every 90 days thereafter.
Telemedicine service for electric stimulation attended, code 97032, is limited to one unit. Providers must document any treatment modifications used to support delivering services via telemedicine. Please refer to the Therapy Services manual for additional coverage information.
SOURCE: SD Medicaid Billing and Policy Manual: Telemedicine, p. 4 (Jun. 2023). (Accessed Aug. 2023).
School District Services – School district providers may provide physical and occupational therapy via telemedicine using CPT code 97799 for physical therapy and CPT code 97139 for occupational therapy. Speech-language pathology services continue to be allowed when provided via telemedicine and should be billed using CPT code 92507. The service must be provided by means of “real-time” interactive telecommunications system and the provider must have a face-to-face visit within the first 30 days and every 90 days thereafter.
Psychology services may also be provided via telemedicine or real time, two-way audio-only using CPT code 90899. Audio-only services must be provided in accordance with the IMHP coverage criteria stated in this manual. Please refer to the School District Services manual for additional coverage information.
SOURCE: SD Medicaid Billing and Policy Manual: Telemedicine, p. 5 (Jun. 2023). (Accessed Aug. 2023).
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. 5, (Apr. 2023), (Accessed Aug. 2023).
CHW Services must be related to an 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 helping a recipient find other relevant community resources such as support groups, and implementing a component of the care plan addressing a Social Determinant of Health (SDoH). 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, (Jul. 2023). (Accessed Aug. 2023).
May psychotherapy be provided via telehealth? Does telehealth meet the definition of face-to-face? Yes, telehealth services are considered face-to-face. Psychotherapy is allowed to be provided via telehealth. Please review the telehealth chapter for more information about telehealth requirements.
Non-covered service
- Mental health treatment provided without the recipient physically present in a face-to-face or telehealth session with the mental health provider except for telehealth treatment and collateral contacts.
- Mental health services provided after the third face-to-face or telehealth session with the recipient if a treatment plan has not been completed.
A provider may not submit a claim for mental health services provided after the third face-to-face or telehealth session with a recipient and before the effective date of the treatment plan.
SOURCE: SD Medicaid Billing and Policy Manual: Independent Mental Health Practitioners, pg. 14, (Jun. 2023), (Accessed Aug. 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. Jun, 2023. (Accessed Aug. 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 (Jun. 2023), (Accessed Aug. 2023).
Telemedicine consultations are covered as outpatient hospital services.
SOURCE: SD Medicaid Billing and Policy Manual: Outpatient Hospital Services, p. 2 (Jun. 2023), (Accessed Aug. 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 (Jun. 2023). (Accessed Aug. 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 (Jun. 2023). (Accessed Aug. 2023).
ELIGIBLE PROVIDERS
In order to receive payment, all eligible servicing and billing provider’s National Provider Identifiers (NPI) must be enrolled with South Dakota Medicaid. Servicing providers acting as a locum tenens provider must enroll in South Dakota Medicaid and be listed on the claim form. Please refer to the provider enrollment chart for additional details on enrollment eligibility and supporting documentation requirements.
The following providers can provide services via telemedicine at a distant site:
- Audiologists
- Certified Social Worker – PIP
- Certified Social Worker – PIP Candidate
- Clinical Nurse Specialists
- Community Health Worker (CHW)
- Community Mental Health Centers
- Dentists
- Diabetes Education Program
- Dieticians
- Federally Qualified Health Center (FQHC)
- Indian Health Services (IHS) Clinics
- Licensed Marriage and Family Therapist
- Licensed Professional Counselor – MH
- Licensed Professional Counselor – working toward MH designation
- Nurse Practitioners
- Nutritionists
- Occupational Therapists
- Physical Therapists
- Physicians
- Physician Assistants
- Podiatrists
- Psychologist
- Rural Health Clinic (RHC)
- Speech Language Pathologists
- Substance Use Disorder Agencies
- Tribal 638 facilities
Distant site locations must be in the United States. Services should be provided at a location consistent with any applicable laws or regulations regarding where services may be provided. The distant site and the originating site cannot be the same clinic/facility location. 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 (Jun. 2023). (Accessed Aug. 2023).
Can speech therapy be provided via telemedicine? Yes, 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, (Jun. 2023), (Accessed Aug. 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. 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. 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 & 12-13 & 14, (Jul. 2023), (Accessed Aug. 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, (Jun. 2023) (Accessed Aug. 2023).
ELIGIBLE SITES
South Dakota Medicaid covers telemedicine services even if the recipient and the provider are located in the same community. 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 sites 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 an enrolled provider to be reimbursed by South Dakota Medicaid. The following providers are eligible to be reimbursed a facility fee for serving as an originating site:
- Office of a physician or practitioner;
- Outpatient Hospital;
- Critical Access Hospital;
- Rural Health Clinic (RHC);
- Federally Qualified Health Center (FQHC);
- Indian Health Service Clinic;
- Community Mental Health Center (CMHC);
- Substance Use Disorder Agency;
- Nursing Facilities; and
- Schools
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 & 9 (Jun. 2023). (Accessed Aug. 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, (Jun. 2023) (Accessed Aug. 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, 13 (Jul. 2023), (Accessed Aug. 2023).
GEOGRAPHIC LIMITS
South Dakota Medicaid covers telemedicine services even if the recipient and the provider are located in the same community. 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 (Jun. 2023), (Accessed Aug. 2023).
FACILITY/TRANSMISSION FEE
Originating sites must be an enrolled provider to be reimbursed by South Dakota Medicaid. The following providers are eligible to be reimbursed a facility fee for serving as an originating site:
- Office of a physician or practitioner;
- Outpatient Hospital;
- Critical Access Hospital;
- Rural Health Clinic (RHC);
- Federally Qualified Health Center (FQHC);
- Indian Health Service Clinic;
- Community Mental Health Center (CMHC);
- Substance Use Disorder Agency;
- Nursing Facilities; and
- Schools
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 sites are not reimbursed for any additional costs associated with equipment, technicians, technology, or personnel utilized in the performance of the telemedicine service. 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.
During the public health emergency, South Dakota Medicaid followed Medicare’s billing guidance allowing providers to bill the originating site fee if a hospital received approval to make a recipient’s home a “hospital location” known to and approved by Medicare. Effective May 11, 2023, providers will no longer be allowed make a recipient’s home a “hospital location” for the purpose of billing 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 in the performance of telemedicine services. The originating site fee is not reimbursable for audio-only services and should not be billed for these services.
An originating site eligible for reimbursement must bill for the service using the HCPCS code Q3014 for CMS 1500 Claims or Revenue code 780 for UB-04 Claims. 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.
SOURCE: SD Medicaid Billing and Policy Manual: Telemedicine, p. 2-3; 7. 9 (Jun. 2023). (Accessed Aug. 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. 10-11, (Mar. 2023), (Accessed Aug. 2023).
Teledentistry
“Originating site”, physical location of the Medicaid recipient at the time the synchronous teledentistry service is provided.
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. 4-6, (Jun. 2023), (Accessed Aug. 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 (Jun. 2023). (Accessed Aug. 2023).
