South Dakota Medicaid

MedicaidSD

ABA billing requirements · Source: South Dakota Medicaid — ABA Services Coverage

High confidence

Verified 2026-03-01

Authorization Requirements

Requires prior auth Yes

Initial auth duration1 months

Renewal auth durationN/A

Submission deadlineN/A

Unit tracking cadenceTotal

Requires FBA Yes

Diagnostic eval validityN/A

Re-eval cadenceN/A

Documentation Requirements

Parent signatures required Yes

Start/stop times required Yes

Treatment plan componentsBaseline data, Target behaviors, Methods

Progress summary cadenceEvery 6 months

Policy Notes

Prior authorization (PA) is required for elective services, including ABA therapy. PA determination takes 30 days, often completed in 2 weeks. Urgent/emergent care is exempt from PA. Retro PAs are possible for urgent/emergent cases. Inpatient hospitalization PAs are expedited (48 hours, 2 business days). Most out-of-state services require PA, except for telemedicine if the recipient is in SD.

CPT & Modifier Rules

CPT rules require a free account

View H-codes, modifiers, unit limits, and billing restrictions for South Dakota Medicaid.

Official policy source:South Dakota Medicaid — ABA Services Coverage

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Data last verified: 2026-03-01 · Confidence: High · See our methodology

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