Behavioral health Medicaid rates in South Dakota lead the country on the most basic outpatient service. South Dakota Medicaid pays $42.50 for mental health counseling on code 98012, which ranks 1st of 12 states and sits 62.3% above the $26.19 national median. Its psychotherapy and assessment rates are also above the median.
Almost every South Dakota behavioral health rate carries a 2026-06-01 effective date, the date of a state inflationary increase, and the state pays these services almost entirely through fee-for-service rather than managed care. Rates are compiled from official South Dakota Medicaid publications, and each rate on the South Dakota Medicaid rates hub links back to its source document.
| Service | Code | SD rate | Rank | vs national median |
|---|---|---|---|---|
| Mental health counseling | 98012 | $42.50 | 1 of 12 | 62.3% |
| Outpatient psychotherapy and evaluation | 90863 | $93.65 | 6 of 28 | 12.4% |
| Mental health assessment (non-physician) | 90791 | $130.75 | 13 of 27 | 4.6% |
| Psychiatric residential treatment | n/a | $508.22 a day | 10 of 15 | -3.2% |
Two more rates are published on units that are not ranked: service plan development on T1007 with modifier HF at $31.76 per 15 minutes, or $127.04 an hour, and wraparound on H2021 with modifiers HS and TL at $44.85. Both took effect 2026-06-01. The full dataset holds all 41,546 current South Dakota Medicaid rates, each linked to its source publication.
South Dakota's $42.50 counseling rate on 98012 sits just ahead of Wyoming ($42.34), and well ahead of the District of Columbia ($35.74), Washington ($34.22) and Wisconsin ($27.43). The lowest states are Connecticut ($21.14), North Carolina ($18.49) and Michigan ($8.62).
Most states that rank for counseling do so on H0046; South Dakota is the only state among the top five on a different code. Providers comparing South Dakota with neighboring states should check that they are comparing the same service and unit.
Rate and wage pointing the same way
For a counseling practice, South Dakota's rate combines with below-median wages. The state's median mental health counselor wage is $25.79 an hour, against $28.53 nationally, so each counseling unit carries more margin than the national averages imply. In most states, a top-ranked rate comes with a high-wage labor market that absorbs part of the advantage. South Dakota is an exception, and that makes counseling a dependable foundation for an outpatient practice here.
South Dakota's outpatient psychotherapy comparison rate is $93.65 on code 90863 with modifiers HE, HW and SA. It ranks 6th of 28, 12.4% above the $83.33 national median. The states ahead of it are California ($302.03), New Mexico ($144.88), North Dakota ($118.28), Nebraska ($115.68) and Wisconsin ($95.02).
The modifier set matters. The comparison line carries three modifiers, and the same code without them, or with a different combination, can carry a different amount. The standard session codes, including 90837, were updated on 2026-07-01 and are listed on the state hub.
Assessment is paid on 90791 with modifiers AM, HE and HK at $130.75. It ranks 13th of 27 and is 4.6% above the $125.00 national median. That places South Dakota in the middle of the pack on intake, ahead of states such as Texas ($28.91) but well behind Missouri ($687.46).
For a practice, a median assessment rate means intake neither subsidizes nor drains the rest of the schedule. Because 90791 also carries a one-year limit, a second full evaluation for the same client within a year is unlikely to be paid; re-assessment needs should be met through the session codes or planning code where the service definition allows.
Service plan development on T1007 pays $31.76 per 15 minutes, or $127.04 an hour, which makes planning time one of the better-paid hours on South Dakota's behavioral health schedule. Wraparound on H2021 pays $44.85 with modifiers HS and TL.
Both rates are published on units that differ from other states' comparison lines, so they are not ranked. For agencies, the planning rate supports thorough treatment plans and care coordination, which in turn support the medical necessity documentation that every other service relies on.
South Dakota lists no prior authorization rules on 90791, 90792, 90832, 90833, 90834, 90836, 90837 or 90838. Instead, 90791, 90792, 90832, 90834 and 90837 each carry a one-year limit. The add-on codes 90833 and 90836 and the longer session code 90838 carry none. Family therapy codes 90847 and 90849 and group therapy on 90853 each carry one prior authorization rule.
For a practice, this means visit counts per member per year need tracking, but there is no authorization step before individual therapy begins. A simple per-client counter in the scheduling system, checked before each session, prevents denials late in the year.
South Dakota pays $508.22 a day for psychiatric residential treatment, effective 2025-06-01. It ranks 10th of 15 and sits 3.2% below the $525.10 national median. Minnesota leads at $1,244.07 and Nebraska is lowest at $283.19.
Unlike the outpatient lines, the residential rate carries a 2025 effective date. Residential operators should check whether the 2026 inflationary increase applies to their rate, since the SFY27 actions may treat residential care separately from the outpatient schedule.
South Dakota's 2026 rate actions explain why its behavioral health effective dates cluster in June:
- SPA SD-26-0002, SFY27 Behavioral Health Inflationary Increase. Submitted to CMS with a 1.4% increase effective 2026-06-01.
- HB 1326 (2026 session), General Appropriations Act SFY2027. It includes behavioral health discretionary provider inflation of 1.4% effective 2026-07-01.
- DSS provider communication. SFY27 Reimbursement Methodology and Rate Updates, effective 2026-07-01.
- SPA SD-26-0005, CY25 Care Coordination Supplemental Payments. Approved by CMS, effective 2026-06-01.
The year before followed the same pattern: SPA SD-25-0007 added Behavioral Health Peer Support Services with an inflationary increase effective 2025-06-01. A modest annual increase applied across the whole behavioral health schedule keeps South Dakota's rates current, and the 2025 peer support addition gives agencies a newer service line to build around.
South Dakota's May 2025 wages are below the national median for every role with data:
- Mental health counselor: $25.79, against $28.53 nationally
- Mental health social worker: $23.52, against $28.98
- Clinical psychologist: $38.52, against $48.36
- Psychiatrist: $108.74, against $135.51
- Nurse practitioner: $61.94, against $63.61
For a South Dakota practice, above-median rates and below-median wages point the same direction. The psychologist and psychiatrist gaps are the widest, which favors testing and prescribing services.
South Dakota pays behavioral health through South Dakota Medicaid fee-for-service, run by the DSS Division of Medical Services. The state also runs the South Dakota Medicaid Primary Care Program (PRIME), a primary care case management program, and South Dakota Medicaid Care Connect, its health home program. Separately, the DSS Division of Behavioral Health funds contract services outside Medicaid. South Dakota's managed care rules are not classified for behavioral health, and our behavioral health data counts 4 plans and designated provider groups. The South Dakota managed care page has the detail.
Without risk-based plans negotiating rates, the published fee schedule is the rate South Dakota providers are paid. That makes the annual inflationary update the single most important event in a South Dakota provider's revenue year.
South Dakota sits in a region of comparatively strong outpatient rates. North Dakota and Nebraska both rank above South Dakota on psychotherapy, while Wyoming nearly matches it on counseling. Minnesota pays the highest residential rate in the country, far above South Dakota's figure, which matters for youth residential operators choosing where to place beds.
For an outpatient practice near a state line, the practical comparison is counseling plus psychotherapy. South Dakota leads on the first and sits close behind its northern neighbor on the second, and its wage levels are lower than the national median for every role. For a residential operator, the comparison runs the other way: South Dakota trails the national median, and Minnesota, its neighbor to the east, pays considerably more per day.
Because each state uses different codes and units for the same service, cross-border comparisons should start from the service and the hourly or per-visit figure rather than from the code number. The national overview groups services this way.
- Reload rates each June and July. The SFY27 increases took effect 2026-06-01 and 2026-07-01.
- Track annual limits. Count 90791, 90832, 90834 and 90837 units per client per year.
- Use the counseling advantage. A top-ranked rate with below-median wages is a strong base for an outpatient practice.
- Benchmark regionally. The Minnesota hub shows a neighboring schedule.
National medians are on the behavioral health Medicaid rates by state overview, and plans for the full dataset are on the pricing page.
Rates are compiled from official South Dakota Medicaid publications, including the South Dakota Medicaid Physician fee schedule for SFY2027. Each rate links to its source document, and South Dakota's history in our data goes back to 1988. Comparison groups match services across codes, and ranks include only states with a comparable rate. Wage figures are May 2025 medians. See the methodology page.