S.D. Admin. R. 67:16:09:05

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

Section 67:16:09:05 - Billing requirements

A claim submitted under this chapter must be submitted at the provider's usual and customary charge and must contain the applicable procedure codes for the chiropractic services provided.

A provider may not bill multiple units of procedure code 72020 if a multiple-view procedure code is applicable. The number of units indicates the number of times a procedure is performed, not the number of views.

A provider may not submit a claim for procedure code 99211 in conjunction with procedure code 99201. A provider may not submit a claim for procedure code 99211 more than once in any 12 month period. Annual claims for procedure code 99211 must show continued medical necessity and progress towards improvement of the condition, negating the possibility of maintenance therapy. An additional claim for procedure code 99211 may be submitted within the 12 month period for a separate and distinct injury with supporting documentation of medical necessity. A provider may not submit a claim for procedure code 99201 or 99211 unless it is the provider's custom to charge the general public for these services.

S.D. Admin. R. 67:16:09:05

SL 1975, ch 16, § 1; 1 SDR 77, effective 5/29/1975; repealed, 3 SDR 26, effective 10/6/1976; readopted, 5 SDR 109, effective 7/1/1979; 7 SDR 66, 7 SDR 89, effective 7/1/1981; 16 SDR 64, effective 10/8/1989; 16 SDR 227, effective 6/24/1990; 17 SDR 200, effective 7/1/1991; 20 SDR 49, effective 10/14/1993; 20 SDR 135, effective 2/22/1994; 33 SDR 137, effective 3/7/2007; 39 SDR 220, effective 6/27/2013.

General Authority: SDCL 28-6-1.

Law Implemented: SDCL 28-6-1.

Third-party liability, ch 67:16:26. Covered services -- Limits, § 67:16:07:03.