S.D. Admin. R. 20:06:54:02

Current through Register Vol. 51, page 67, December 16, 2024

Section 20:06:54:02 - Coverage for office visits in conjunction with preventive items and services

If an item or service described in § 20:06:54:01 is billed separately or is tracked as individual encounter data separately from an office visit, then a plan or issuer may impose cost-sharing requirements with respect to the office visit.

If an item or service described in § 20:06:54:01 is not billed separately or is not tracked as individual encounter data separately from an office visit and the primary purpose of the office visit is the delivery of such an item or service, then a plan or issuer may not impose cost-sharing requirements with respect to the office visit. If an item or service described in § 20:06:54:01 is not billed separately or is not tracked as individual encounter data separately from an office visit and the primary purpose of the office visit is not the delivery of such an item or service, then a plan or issuer may impose cost-sharing requirements with respect to the office visit.

S.D. Admin. R. 20:06:54:02

37 SDR 63, effective 9/23/2010; 37 SDR 111, effective 12/7/2010.

General Authority: SDCL 58-17-87, 58-18-79.

Law Implemented: SDCL 58-17-1.1, 58-17-1.2, 58-17-62, 58-17-87, 58-17-98, 58-18-36, 58-18-41, 58-18-79, 58-18-80, 58-18-83.