MedicaidBilling CodesMedium impact
Evaluation and Management Audio-Only Billing Updates
South Dakota Medicaid·SD·Telehealth
Effective date
Jul 1, 2025
We identified it
Jun 21, 2026
Summary
South Dakota Medicaid is replacing discontinued telephone consultation codes (98966-98968) with new audio-only E/M codes (98012-98015) for established patient visits. The new codes have specific time and medical decision-making requirements with updated reimbursement rates.
Action Required
By July 1, 2025: Billing team must update system to discontinue codes 98966, 98967, and 98968 for South Dakota Medicaid. Replace with new audio-only E/M codes 98012-98015 based on medical decision-making complexity and time requirements. Update fee schedules with new rates: 98012 ($31.01), 98013 ($54.23), 98014 ($78.77), 98015 ($114.73). Train providers on time and complexity documentation requirements.