South Dakota Medicaid Telehealth Reimbursement

 Medicaid Reimbursement / Posted 6 months ago by Telehealthist

South Dakota Medicaid provides reimbursement for live video, under some circumstances. Reimbursement is not provided for store-and-forward or remote patient monitoring services.

Definitions
“Telemedicine is the use of an interactive telecommunications system to provide two-way, real-time, interactive communication between a provider and a Medicaid recipient across a distance.”

Live Video
Policy
South Dakota Medicaid will reimburse for limited services via live video. Providers are reimbursed the lesser of their usual and customary charge or the fee schedule rate. See manual for complete list of CPT codes. The maximum allowable amount for services provided via telemedicine is the same as services provided in-person.

Eligible Services/Specialties
See manuals for specific CPT codes.

Eligible Providers
Click for a list of eligible providers.

Eligible Sites
Originating sites must be enrolled with South Dakota Medicaid.

Geographic Limits
An originating site may not be located in the same community as the distant site, unless the originating site is a nursing facility.

Facility/Transmission Fee
Originating sites are eligible for a facility fee. Click to see list of sites eligible for fee.

Store-and-Forward
Policy
South Dakota Medicaid defines telemedicine as occurring in “real-time”, excluding store-and-forward applications.

Eligible Services/Specialties
No reference found.

Geographic Limits
No reference found.

Transmission Fee
No reference found.

Remote Patient Monitoring
Policy
The Office of Adult Services and Aging defines “telehealth services” as a home-based health monitoring system used to collect and transmit an individual’s clinical data for monitoring and interpretation. However, no further information is provided.

Conditions
No reference found.

Provider Limitations
No reference found.

Other Restrictions
No reference found.

Email/Phone/Fax
No reimbursement for phone. No reimbursement for email. No reimbursement for facsimile.

Consent
No reference found.

Out of State Providers
All telemedicine services outside South Dakota must comply with South Dakota Medicaid’s out-of-state prior authorization requirements.

Miscellaneous
Originating sites eligible for reimbursement must bill for the service using HCPCS Q3014.