MedicaidCoverageMedium impact
Chief Medical Officer Quarterly Updates
South Dakota Medicaid·SD · Family Medicine, Internal Medicine, OB-GYN +3 more·Provider Communication
Effective date
Apr 1, 2024
We identified it
Jun 21, 2026
Summary
South Dakota Medicaid has implemented several billing updates including coverage for over-the-counter iron prescriptions for pregnant women, new cognitive assessment billing (CPT 99483), urgent care billing clarifications, and new prior authorization requirements for six physician-administered drugs.
Action Required
Immediately: Update billing systems to bill CPT 99483 for cognitive assessments up to once every 180 days. For urgent care visits, ensure Block 10d contains 'U' or '2' on CMS 1500 forms and use 'Y' in 24c electronically. Obtain prior authorization for Teplizumab, Evinacumab, Sutimlimab, Pegloticase, Brexanolone, and Esketamine before administration. Verify urgent care visit limits using Provider Portal service limits function.