S.D. Admin. R. 67:16:25:08.03
A claim for air ambulance must be submitted at the provider's usual and customary charge. A provider may bill for services only if a recipient was actually transported. A provider may not bill for any portion of ambulance service during which the recipient was not physically present in the air ambulance.
A claim for emergency air ambulance services must contain the applicable procedure codes for the services provided.
Charges for transporting the patient from the airport to the hospital or from the hospital to the airport must be billed by the ground ambulance provider and may not be included in the air ambulance charge. If an extra patient is transported with the recipient, the provider must add the modifier "TK" to the procedure code being billed.
A copy of the physician or other licensed practitioner's written order specifying the medical necessity and the level of air transportation medically required must be maintained in the provider's records and made available on request.
S.D. Admin. R. 67:16:25:08.03
General Authority: SDCL 28-6-1(1)(2)(4)
Law Implemented: SDCL 28-6-1(1)(2)(4)