Rule 67:16:37:14 Billing requirements.
67:16:37:14. Billing requirements. A school
district submitting a claim for covered services under this chapter must submit
the claim at its usual and customary charge.
school district must submit the claim when the service is listed in the child's
individual education plan and is covered under this chapter. Services provided
to an individual who has been admitted to a hospital as an inpatient, or who is
residing in a residential treatment center, a nursing facility, or an
intermediate care facility for the mentally retarded are exempt from the
provisions of this rule. Claims for these services must be submitted according
to the applicable chapters of article 67:16.
provider, other than those listed above, may not submit claims for services
which the provider knows or should have known are services listed in the
child's individual education plan.
submitted for psychological services listed in § 67:16:37:06 must use
procedure code 90899 and may not exceed 60 hours in any 12 month period;
submitted for physical therapy services must use procedure code 97799.
submitted for occupational therapy services must use procedure code W4510.
submitted for speech therapy services must use procedure code 92507.
submitted for audiology services must use procedure code 92599.
submitted for nursing services listed in § 67:16:37:11 must use procedure
Source: 18 SDR 78, effective November 4, 1991; 18 SDR 224,
effective July 13, 1992.
General Authority: SDCL 28-6-1.
Law Implemented: SDCL 28-6-1.
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