Telehealth rules changed in South Dakota for 2026 — here's what's different

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South Dakota telehealth policy has been through two major shifts in the past three years. First, the state’s Medicaid expansion took effect in July 2023, suddenly making hundreds of thousands of newly insured adults eligible for covered telehealth services. Second, CMS and state rule updates in 2024 and 2025 clarified and in some cases expanded what SD Medicaid will reimburse via telehealth. For 2026, the framework is clearer than it has been since expansion launched.

What changed: Medicaid expansion meets telehealth

Before Amendment D passed in 2022, South Dakota’s Medicaid coverage was among the most restricted in the country for working-age adults. Expansion changed that, and with it came the need for SD Medicaid to define telehealth rules for the newly covered population.

SD Medicaid covers telehealth under its fee-for-service structure (unlike states with mandatory Medicaid managed care, South Dakota’s Medicaid is primarily FFS for most populations). The South Dakota Department of Social Services has issued updated telehealth billing guidance that applies to expansion enrollees, with these key elements:

Originating site: The home is an accepted originating site for synchronous telehealth for primary care and behavioral health visits. This is significant for rural counties — patients in Dewey, Ziebach, Buffalo, or Corson counties can receive primary care and mental health services via video without traveling to Mobridge or other regional centers.

Audio-only: SD Medicaid reimburses audio-only (telephone) visits for behavioral health services under specific conditions. This mirrors the approach of most state Medicaid programs that maintained some audio-only coverage after pandemic-era flexibilities expired.

APRN services via telehealth: Given South Dakota’s APRN collaborative-agreement requirement, a telehealth provider delivering services to South Dakota patients must either hold a South Dakota license or qualify under an interstate agreement. The collaborative agreement must cover telehealth delivery explicitly if the APRN is using telemedicine to reach patients.

What SD Medicaid covers via telehealth in 2026

SD Medicaid covers synchronous audio-video telehealth for:

  • Primary care visits (CPT 99213, 99214 with POS 10 for home or 02 for facility)
  • Individual psychotherapy (CPT 90837)
  • Psychiatric evaluation and medication management
  • Substance use disorder counseling
  • Certain chronic care management services

Modifier GT (synchronous audio-video) is required on SD Medicaid telehealth claims. Place of Service code 10 (patient in home) was formally adopted by SD Medicaid’s billing system following CMS’s universal adoption in 2022. The SD DSS provider billing manual is the authoritative source — verify modifier and POS requirements before submitting the first claim, as manual updates can lag behind policy changes.

ICD-10 behavioral health codes F32.9 (major depressive disorder) and F41.1 (generalized anxiety disorder) are covered via telehealth under SD Medicaid.

Indian Health Service and tribal telehealth considerations

South Dakota is home to nine federally recognized tribal nations, and IHS facilities serve a significant portion of the state’s healthcare need — particularly in western counties. IHS telehealth rules run on federal frameworks separate from SD Medicaid. Tribal members may carry both IHS eligibility and SD Medicaid coverage, with coordination of benefits rules applying.

IHS expanded telehealth substantially during and after the pandemic, and most service units now offer synchronous video visits for primary care and behavioral health. Tribal members with questions about telehealth availability through IHS service units can contact their local unit directly.

CMS updates affecting South Dakota providers in 2025–2026

CMS’s 2025 Physician Fee Schedule final rule extended several telehealth provisions that affect South Dakota providers billing Medicare:

  • The rural originating-site waiver, which allows Medicare patients in non-rural areas to receive telehealth at home, was extended through a continuing resolution framework
  • Mental health telehealth flexibilities — including audio-only coverage for behavioral health — were extended pending further rulemaking
  • Federally Qualified Health Centers and Rural Health Clinics can serve as distant sites for Medicare telehealth, a provision particularly relevant in western South Dakota

South Dakota providers billing Medicare should verify the CMS Telehealth Services list annually, as eligible service codes are updated each calendar year through the PFS final rule.

What this means for South Dakota patients and providers

For patients: if you enrolled in SD Medicaid after July 2023, you have access to covered telehealth for primary care and behavioral health services from your home. You do not need to travel to Sioux Falls or Rapid City for a routine visit. Your provider must hold a South Dakota license and be enrolled with SD Medicaid.

For providers: the fee-for-service structure of SD Medicaid simplifies billing compared to multi-MCO states. A single SD DSS provider enrollment covers Medicaid telehealth billing for all expansion enrollees. The modifier and POS code requirements are straightforward — the most common errors are outdated modifier codes and missing consent documentation.

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This post was drafted by AI and reviewed by our editorial team. Last updated 2026-05-28.