South Dakota Telemedicine & Telehealth Reimbursement Overview

Provider Reimbursement Eligibility
Consent for Telemedicine Live Video Reimbursement Store & Forward Reimbursement Originating Site & Transmission Fees Eligible Practitioners
State Law

No Reference Found

SB137 includes “interactive audio-video”, interpreted as covering for the service of live video.

Effective January 1, 2020.

No Reference Found

No Reference Found

No Reference Found

Medicaid

No Reference Found

South Dakota Medicaid will reimburse for limited services at the same rate as in-person services.  See manual for a complete list of CPT codes.

See SD Medical Assistance Program, Professional Svcs. Manual, p. 18-21

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

See SD Medical Assistance Program, Professional Svcs. Manual, p. 18

Originating sites are eligible for a facility fee.  They may not be located in the same community as the distant site unless the originating site is a nursing facility.

See SD Medical Assistance Program, Professional Svcs. Manual, p. 18 & 21

One of 19 States that does not specify the type of healthcare provider allowed to practice telemedicine.  Offering the most flexibility.

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

See Telemedicine Reimbursement Guide – Medicare Section

See Telemedicine Reimbursement Guide – Medicare Section

See Telemedicine Reimbursement Guide – Medicare Section

See Telemedicine Reimbursement Guide – Medicare Section

Private Payors

Private payors are actively exploring telemedicine and telehealth, but each provider is different. If you are in network with a specific provider, call and request documentation of their policy related to telehealth.

Self Pay

There are no limitations for self pay patients/clients, and providing telehealth services is a great way to increase revenue with patients that are selfpay or value premium services.

Provider Reimbursement Eligibility
Consent for Telemedicine
State Law

No Reference Found

Medicaid

No Reference Found

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Live Video Reimbursement
State Law

SB137 includes “interactive audio-video”, interpreted as covering for the service of live video.

Effective January 1, 2020.

Medicaid

South Dakota Medicaid will reimburse for limited services at the same rate as in-person services.  See manual for a complete list of CPT codes.

See SD Medical Assistance Program, Professional Svcs. Manual, p. 18-21

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Store & Forward Reimbursement
State Law

No Reference Found

Medicaid

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

See SD Medical Assistance Program, Professional Svcs. Manual, p. 18

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Originating Site & Transmission Fees
State Law

No Reference Found

Medicaid

Originating sites are eligible for a facility fee.  They may not be located in the same community as the distant site unless the originating site is a nursing facility.

See SD Medical Assistance Program, Professional Svcs. Manual, p. 18 & 21

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Eligible Practitioners
State Law

No Reference Found

Medicaid

One of 19 States that does not specify the type of healthcare provider allowed to practice telemedicine.  Offering the most flexibility.

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Private Payors

Private payors are actively exploring telemedicine and telehealth, but each provider is different. If you are in network with a specific provider, call and request documentation of their policy related to telehealth.

Self Pay

There are no limitations for self pay patients/clients, and providing telehealth services is a great way to increase revenue with patients that are selfpay or value premium services.

Telemedicine CPT Codes

Unique CPT codes do not exist specifically for telemedicine or telehealth. Instead a modifier is applied to existing codes.

  • For interactive audio and video sessions, place a GT modifier in front of the CPT codes you typically use for in person services.
  • For services provided via an asynchronous telecommunication system, simply add a GQ modifier in front of the CPT codes you typically use for in person services.

Telehealth Parity

South Dakota signed SB137, mandating that “No health insurer may exclude a service for coverage solely because the service is provided through telehealth and not provided through in-person consultation or contact between a health care professional and a patient.”

Effective January 1, 2020.

Definitions

Telehealth Parity

Telehealth services are equal to in person services and reimbursed at the same rate.

Asynchronous Communication

The exchange of messages, such as among the hosts on a network or devices in a computer, by reading and responding as schedules permit rather than according to some clock that is synchronized for both the sender and receiver or in real time. Email, chat and text messaging are primary examples of asynchronous communication.

Distant or Hub Site

The location or site where the practitioner or provider is located while utilizing telemedicine services to meet with patients.

Originating Site

The location of the patient at the time services are provided. An originating site can be the client's home or a public facility like a rural hospital or physician's office. Many payors will reimburse for an originating site fee if it meets specific requirements. Rural use cases provide an applicable example for an eligible originating site fee where the patient will go to a local medical facility like a primary care physician's office and meet with a specialist located in distant urban health facility.

Additional Telemedicine Resources

Telehealth and telemedicine are fast growing and changing segments. Both state licensure and state legislation are changing rapidly along with federal legislation and for this reason the information provided cannot be considered legal advice. We make every attempt to keep state specific information up to date, but encourage you to validate this information through the following sites: