MedicaidCoverageMedium impact
Winter Provider Newsletter
South Dakota Medicaid·SD · OB-GYN, Family Medicine, Optometry +1 more·Education
Effective date
Jan 1, 2025
We identified it
Jun 21, 2026
Summary
South Dakota Medicaid implemented coverage for doula services and justice involved youth case management effective January 1, 2025. The policy also includes billing reminders for FQHC/RHC providers to use TH modifier for prenatal care and specific codes for postpartum visits and high index lenses.
Action Required
Immediately: For South Dakota Medicaid providers - Update billing systems to include new doula service codes and justice involved youth case management services. FQHC, RHC, IHS, and Tribal 638 providers must append TH modifier to applicable EM codes for prenatal care (except initial confirmatory visit) and bill comprehensive postpartum visits using 59430 instead of EM codes. Eye care providers must use V2782 or V2783 for high index lenses, not modifier 22 on other codes.