S.D. Admin. R. 67:16:14:06.06

Current through Register Vol. 51, page 57, November 12, 2024

Section 67:16:14:06.06 - Payment for drugs dispensed by physician

Payment for items covered under this chapter and dispensed by a physician or other licensed practitioner is made according to one of the following:

(1) If a pharmacy is not available in the provider's service area, payment is made according to § 67:16:14:06;

(2) If a pharmacy is available in the provider's service area, payment is limited to the provider's cost of the item; or

(3) If the physician is a PHS provider and the drug being dispensed is covered under the PHS program, payment is made according to § 67:16:14:06.09.

If submitting a claim for services provided under subdivision (2) or (3) of this section, the physician or other licensed practitioner must maintain a copy of the supplier's invoice showing the actual cost of the item to the provider. At the department's request, the provider must furnish a copy of the invoice to substantiate the claim.

S.D. Admin. R. 67:16:14:06.06

Transferred from; 44 SDR 94, effective 12/4/2017

General Authority: SDCL 28-6-1.

Law Implemented: SDCL 28-6-1(1)(2).

Definition of "cost," § 67:16:14:01.