South Dakota billing rules 2026.06.19-current
South Dakota Medicaid doula billing rules
Check South Dakota rates, codes, setup steps, visit-note basics, and denial risks before claim entry.
Quick path
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- 1Find the rule for your stateStart with the state where the client has Medicaid coverage.Choose your state
- 2Check what is missingReview setup, visit notes, codes, and payer steps before billing.Use the checklist
- 3Save the checklistDownload the checklist, then keep client details in your own secure records.Open checklist
South Dakota Medicaid doula billing rules
South Dakota uses per-visit service lines such as Prenatal, postpartum, or care coordination doula services (per 15 minutes) at $16.87, with modifiers, caps, and documentation checks to confirm before claim entry.
Recently updated
Updated Jun 19, 2026- Checked South Dakota Department of Social Services / SD Medicaid: SD Medicaid Doula Services Billing and Policy Manual.
- Checked South Dakota Department of Social Services / SD Medicaid: SD Medicaid Doula Services Fee Schedule.
Paid by visit
Prenatal, postpartum, or care coordination doula services (per 15 minutes): $16.87
Labor and delivery doula services (per delivery): $600
What to check before billing
- Doula services require a referral from a physician, physician assistant, certified nurse practitioner, or certified nurse midwife with whom the recipient had a face-to-face or telemedicine visit within the last 90 days (or the care management program provider for BabyReady, Primary Care Provider Program, or Care Connect members); referrals may be retroactive up to 60 days.
- Bill T1032 in 15-minute units; a unit is attained only when the 8-minute midpoint is passed, and same-day time is cumulative across visits.
- South Dakota Medicaid covers a maximum of $1,800 of doula services per pregnancy (per recipient within an 18-month period); exceeding it requires prior authorization via the General Prior Authorization Form.
- One T1033 labor and delivery visit is covered per recipient per pregnancy; the doula must be physically present and L&D must be billed in conjunction with prenatal and/or postpartum services.
- Postpartum services may be provided up to 365 days after the end of pregnancy; care coordination, prenatal, and postpartum services may be face-to-face, telemedicine (GT modifier), or two-way audio-only (93 modifier) when documented.
- Submit on a CMS-1500 or 837P; claims must be filed within 6 months of the date of service and records retained for at least 6 years.
This page is built from checked state billing sources.
Use nicknames on public pages.
Keep client names, IDs, claim numbers, and visit notes in your own records.
Provider setup
These state tools are available for planning. Confirm payer requirements before billing.
Launch status
active
Active: guide and tools are ready for general planning.
Billing portal
SD Medicaid Online Portal (DSS); CMS-1500 / 837P
- Confirm SD Medicaid Online Portal (DSS); CMS-1500 / 837P access and provider enrollment before first-claim work.
- Keep SD Medicaid provider ID / NPI in your own secure records.
- Keep South Dakota Medicaid recipient ID, names, dates of birth, and visit notes out of public pages.
State tools
Choose the question you need help with now.
Provider setup checklist
Enrollment and provider details checklist.
Claim checklist worksheet
Download a plain text checklist.
Check missing items
Find setup, eligibility, rate, and note gaps.
Rate reference
See how this state pays.
Prior authorization
Check whether approval is needed.
Check visit-note requirements
See what the note must support.
Fix denied claims
State-specific denial reasons.
Denied claim help
Review common denial reasons and the next step to check.
Missing licensed-practitioner referral
Obtain and retain the referral (or care management program referral) before billing; it may be retroactive up to 60 days.
Per-pregnancy maximum exceeded
Tally prior doula payments and request prior authorization on the General Prior Authorization Form before exceeding $1,800.
Labor and delivery limit reached
Confirm T1033 has not already been billed for this pregnancy and that prenatal/postpartum services were also provided.
T1032 unit time not met
Recount cumulative same-day minutes before billing T1032 units.
Common questions
Plain answers about South Dakota Medicaid doula billing.
Does South Dakota Medicaid cover doula services?
Yes. South Dakota Medicaid doula services covers doula services. Coverage still depends on active eligibility, the service date, provider setup, and visit notes.
How much does South Dakota Medicaid pay doulas?
South Dakota pays per visit — Prenatal, postpartum, or care coordination doula services (per 15 minutes): $16.87; Labor and delivery doula services (per delivery): $600. Use the South Dakota rate reference to check current amounts against official sources.
What should my South Dakota visit note include?
South Dakota lists 6 visit-note checks to review before claim entry, starting with: Doula services require a referral from a physician, physician assistant, certified nurse practitioner, or certified nurse midwife with whom the recipient had a face-to-face or telemedicine visit within the last 90 days (or the care management program provider for BabyReady, Primary Care Provider Program, or Care Connect members); referrals may be retroactive up to 60 days.. See the South Dakota visit-note checklist for the full list.
Why do South Dakota doula Medicaid claims get denied?
Common reasons include missing licensed-practitioner referral; per-pregnancy maximum exceeded; labor and delivery limit reached. The South Dakota denied-claim guide lists the next step for each.
Official sources
Check these official sources before billing.
Source review
Source review currentSouth Dakota sources on this page were last checked Jun 19, 2026. Use the linked payer sources as the source of truth before billing.
These payer links were checked within the last 90 days.
Need a PDF copy?
PDF export is in the paid tools, where saved state guides and checklist downloads stay with your account.