S.D. Admin. R. 67:16:02:04

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

Section 67:16:02:04 - Physician's services covered

Physician's services covered are limited to the following professional services, which must be medically necessary and provided by a physician or other licensed practitioner to a recipient:

(1) Medical and surgical services;

(2) Services and supplies furnished incidental to the professional services of a physician or other licensed practitioner;

(3) Psychiatric services;

(4) Drugs and biologicals administered which cannot be self-administered;

(5) Routine physical examinations;

(6) Routine visits to a nursing facility, a home and community-based service provider, an intermediate care facility for individuals with intellectual disabilities, or a home and community-based waiver service provider;

(7) Cosmetic surgery when incidental to prompt repair following an accidental injury or for the improvement of the functioning of a malformed body member;

(8) Family planning services;

(9) Pap smears;

(10) Dialysis treatments;

(11) Hysterectomies as authorized under 42 C.F.R. §§ 441.250 to 441.259, inclusive, as amended to April 1, 2017; and

(12) Hyperbaric oxygen therapy if the requirements listed on the department's prior authorization website are met.

S.D. Admin. R. 67:16:02:04

SL 1975, ch 16; 42 SDR 51, effective 10/13/2015; 44 SDR 94, effective 12/4/2017

General Authority: SDCL 28-6-1.

Law Implemented: SDCL 28-6-1(1)(2).

Home and community-based services, ch 67:54:04. HCBS waiver operated by the Division of Adult Services and Aging, ch 67:44:03. Covered services must be medically necessary, § 67:16:01:06.02.