South Dakota Medicaid pays $89.93 for code 99213, the standard return-patient office visit, from July 1, 2026. That ranks 12 of 46 states, above the $75.27 national median and close to the $93.20 Medicare rate. The South Dakota Medicaid fee schedule was reset on July 1, 2026 for state fiscal year 2027. Nearly every common code we track carries the same July 1, 2026 effective date, so the SFY2027 schedule is the one that matters for current claims.
South Dakota is also straightforward to read, because almost everything is fee-for-service. We record no risk-based managed-care lines and no directed payment programs. The published rate is the rate. We hold 41,546 current South Dakota Medicaid reimbursement rates across 146 service categories and 10 programs, drawn from 58 source documents, with history back to 1988.
South Dakota Medicaid fee schedules for SFY2027
The DSS Division of Medical Services runs South Dakota Medicaid fee-for-service, which holds 41,329 of the current rates. Rates here are compiled from official state publications, and each one links to its source. South Dakota publishes most schedules as Power BI reports:
- South Dakota Medicaid Physician fee schedule (SFY2027): 14,524 physician and practitioner rates.
- Outpatient Hospital Prospective Payment System Fee Schedule (for claims paid after July 30, 2026): close behind at 14,166 hospital outpatient rates.
- ASC, Laboratory and DME fee schedules, all for SFY2027.
- Drugs and Biologicals fee schedule, CY2026 Q4, effective October 1, 2026.
- Anesthesia fee schedule, CY2026, effective January 1, 2026.
- List of Diagnostic Related Groups, FFY27, for inpatient payment.
Programs outside the main schedule include:
- the CHOICES Waiver for comprehensive developmental disabilities services;
- the Family Support 360 Waiver for in-home supports;
- the HOPE Waiver for elderly adults and adults with physical disabilities;
- the Assistive Daily Living Services (ADLS) Waiver;
- Care Connect, the health home program;
- the Primary Care Program;
- encounter rates for IHS and Tribal 638 facilities.
The DSS Division of Behavioral Health also publishes state-funded, non-Medicaid contract rates.
South Dakota Medicaid rates for common codes
| Code | What it is | SD rate | National median | SD rank |
|---|---|---|---|---|
| 99213 | Return-patient office visit, level 3 | $89.93 | $75.27 | 12 of 46 |
| 90837 | Hour-long psychotherapy | $160.73 | $132.38 | 9 of 48 |
| 97153 | ABA by a technician (15 min) | $21.73 | $15.86 | 7 of 42 |
| S5125 | Attendant care (15 min) | $11.17 | $6.47 | 4 of 31 |
| T1019 | Personal care (15 min) | $11.17 | $7.07 | 7 of 39 |
The pattern is consistent top-third pay:
- 99215 pays $181.16, rank 10 of 46.
- The highest-level emergency visit, 99285, pays $160.70, rank 12 of 48.
- The preventive visit 99396 pays $121.85, rank 9 of 46.
- Speech therapy (92507) pays $73.27, rank 9 of 44.
- Therapeutic exercise (97110) pays $27.83, rank 10 of 48, or 96% of Medicare.
ABA is strong across the board. Analyst-led 97155 pays $39.00 per unit, rank 6 of 41, and assessment code 97151 pays $35.63, rank 15 of 41.
Personal care, attendant care and home health aide services share one rate: $11.17 per 15 minutes, or $44.68 an hour.
Two codes run against the trend:
- The 90791 assessment pays $130.75, rank 28 of 44, below the $141.74 national median.
- Code H0031 shows $6.52 per service, last of 31 states.
Advanced life support ambulance (A0427) pays $266.09, rank 31 of 44.
No managed care: how South Dakota Medicaid pays
South Dakota does not route Medicaid through risk-based managed-care plans in our data. We classify no service lines under managed-care rules and record no directed payment programs. The named arrangements are:
- PRIME primary care case management providers;
- Care Connect health home designated providers;
- BabyReady designated providers;
- Delta Dental of South Dakota as the dental vendor.
For providers, this removes a layer of uncertainty. A South Dakota Medicaid claim is paid at the published fee schedule rate, with no plan contract in between. Value-based payments come on top: DSS announced on September 18, 2026 that Medicaid issued $9 million in value based payments. A July 20, 2026 SD Register notice proposed adding a new Primary Care Program value-based payment to the state plan. See the South Dakota managed-care page for the program details.
SFY2027 rate changes: HB 1326
South Dakota's SFY2027 rate changes came through its budget. HB 1326, the 2026 General Appropriations Act for SFY2027, took effect July 1, 2026 and included:
- discretionary provider inflation of 1.4% for Medical Services;
- discretionary provider inflation of 1.4% for Behavioral Health;
- mandatory inflation to Medicaid and Medicare providers;
- support for critical access hospitals and for federally qualified health centers.
The Governor's recommended FY2027 Social Services budget had proposed increases of $14,072,438 in general funds and $17,118,717 in federal fund expenditure authority for mandatory increases.
South Dakota industry rates
- Behavioral health: South Dakota counseling pays $42.50 under code 98012, the highest of 12 states and 62.3% above the median.
- IDD: IDD in-home supports under T2017 pay $69.28 an hour, rank 2 of 29, behind only South Carolina, and 98.4% above the median.
- Private duty nursing: South Dakota private duty nursing on S9123 pays $92.80 an hour, rank 6 of 43.
- ABA: on the hourly comparison, South Dakota ABA technician time comes to $86.92, rank 6 of 42 and 37.0% above the median.
- Therapy: physical therapy pays $111.32 an hour, rank 13 of 49.
- Hospice: routine home care pays $186.33 a day from October 1, 2026, level with the national median.
How South Dakota compares with nearby states
On 99213, South Dakota's $89.93 trails only North Dakota ($105.14) among its neighbors:
- Nebraska pays $85.69.
- Minnesota pays $73.99.
- Missouri pays $67.21.
- Iowa pays $43.23.
- Kansas pays $42.07.
On ABA the order changes. Iowa pays $28.59 for 97153, above South Dakota's $21.73, while North Dakota pays $10.81. See our methodology for how rates are compiled.
Updated 2026-10-05