ARSD 67:16:07:05. Rate of payment

A claim submitted under this chapter must be submitted at the podiatrist's usual and customary charge. Except for bilateral or multiple surgeries, payment is limited to the lesser of the provider's usual and customary charge or the fee listed on the department's website. If no fee is listed, payment is limited to 40 percent of the provider's usual and customary charge. The maximum rate of payment for covered podiatry services is available on the department's fee schedule website. If a provider performs bilateral or multiple surgeries during the same operating session, the department must follow the payment methodology established in chapter 67:16:02. A provider may request that the rate of payment be amended. The request must be in writing and directed to the department's state Medicaid director. The provider shall specify the reason for the requested change. The department shall review the request and determine whether the rate change is warranted and whether there is sufficient revenue to cover the change. When the department takes final action on the requested change, the department shall notify the podiatrist who requested the change. A change in a payment rate is reflected on the department's fee schedule website.