South Dakota Medicaid transportation fee schedule: secure van, stretcher, and community rates

NEMT codes and fees from July 1, 2026

One two-page Transportation Services Fee Schedule carries South Dakota Medicaid’s ambulance, air ambulance, and NEMT rates. The NEMT part has two sections, secure transportation and community transportation, and each fee is the maximum the state pays. These are the rates effective July 1, 2026.

Secure transportation (wheelchair and stretcher riders):

Community transportation (ambulatory riders):

Charge Medicaid your usual and customary rate. South Dakota pays that or the fee above, whichever is lower.

A 4 percent targeted raise on July 1, 2026

Every NEMT rate above is 4 percent higher than it was in July 2025. The Department of Social Services gave services without a targeted increase or rebase a 1.4 percent inflationary increase for state fiscal year 2027, as funded by the 2026 Legislature. Community and secure transportation services instead got a targeted increase, set out code by code in the department’s state plan notice in the South Dakota Register of June 29, 2026.

T2001 also changed its description. The 2025 schedule listed it as an accompanying adult for a child age 20 or younger. The 2026 schedule calls it a patient attendant or escort, which matches the manuals: a companion is covered for riders 20 and under, or when the rider medically needs someone along. If a parent or companion rides at no charge under your policy, leave T2001 off the claim. Otherwise, bill no more than one T2001 unit for each one-way trip, at your usual and customary rate.

For context, the same schedule raised the non-emergent BLS ambulance base (A0428) from $255.71 to $280.09. A stretcher van trip at $109.66 remains well under half that.

Secure and community transportation are separate enrollments

South Dakota splits NEMT into two provider types, and the codes you can bill depend on which you hold.

A secure provider that wants to run ambulatory trips needs a second enrollment as a community transportation provider, and billing community trips with secure codes is treated as fraud and abuse of the program. Community transportation providers must be domiciled in South Dakota or enrolled with Medicaid in their home state. An ambulance company may enroll as a secure provider and bill secure rates. The manuals count a rider as confined to a wheelchair only if they cannot walk in any circumstances or need a person helping them the entire time. A rider discharged in a wheelchair is not automatically wheelchair-confined.

Providers may limit their hours or service area, but within those limits they must serve every Medicaid recipient who asks. IHS and Tribal 638 transportation providers may keep secure trips to people who qualify for IHS or 638 care. The South Dakota state guide covers ARSD 67:16:25’s driver, vehicle, inspection, and $1 million insurance requirements for secure providers.

Modifiers that change the payment

South Dakota uses modifiers to scale the base fee rather than adding separate codes. The department’s modifier list sets the payment effect for each:

• TK, additional recipient: 50 percent of the fee. Use it for each extra Medicaid rider on the same trip. The TK modifier entry explains the convention.
• QM, hospital-arranged discharge: 150 percent. A0130 only, for a pickup when a rider is discharged from an inpatient hospital stay and the hospital called you to arrange it. Not for outpatient pickups, clinics, or appointments.
• TN, outside city limits: 150 percent. Community transportation’s A0120 outside city.
• 59, distinct service. For additional trips by one rider on one date of service.

The multiple-trip rule caps a date of service at four one-way trips. The manuals give billing patterns. A rider who goes from home to one provider and back, then later to a second provider and back, bills the base code at 2 units on line one and at 2 units with modifier 59 on line two. A rider who visits two providers in a row and then goes home bills two units, then one unit with 59. A third round trip is the rider’s responsibility.

Mileage: city limits and the 21-mile threshold

South Dakota pays no mileage inside a city, and the two provider types have different outside-the-city rules.

Secure and stretcher vans. Loaded mileage (S0209 or T2049) is billable only on trips that go beyond city limits, counted from where the trip crosses the city line to the destination. The provider needs legal authority to operate outside the city. Oxygen and its supplies are included in the base fee.

Community transportation. S0215 needs a one-way trip of at least 21 miles that leaves city limits. It covers only the actual miles between the two cities, not in-town driving. Unloaded miles can also bill under S0215 on the same distance terms, in two cases: the van is heading back to where the trip began after a drop-off, or it is driving to a hospital or nursing home to collect a discharged rider.

For both types, bill whole miles using standard rounding, and put the trip’s single mileage charge on one rider’s claim, even with several riders aboard. The mileage billing guide covers how to document miles that start at a city line.

Worked examples, labeled as such:

1. A hypothetical secure van trip from a rider’s home to a clinic 60 miles away, with 55 of those miles outside city limits, pays $43.39 + 55 × $2.61 = $186.94.
2. The same ride arranged by a hospital at inpatient discharge pays $65.09 + $143.55 = $208.64.
3. A hypothetical minibus trip outside city limits covering 30 miles between towns pays $7.80 + 30 × $1.04 = $39.00.

Codes the schedule leaves off

South Dakota’s schedule is short, and the missing codes matter as much as the ones on it.

• No waiting time. There is no T2007, and neither manual lists waiting among covered services.
• No T2003. Ambulatory trips bill A0100 or A0120 through community transportation.
• No A0080 or A0090. Mileage for a recipient, an escort, a volunteer driver, or a nonprofit service organization is listed without a procedure code at $0.70 a mile (effective December 1, 2025). Riders claim it through the state’s Non-Emergency Medical Travel program for trips between cities.
• No A0180 to A0210. Overnight meals are $40 a day without lodging and $150 a day with lodging, paid only when the provider is 150 or more miles from the rider’s home city and the stay is for specialty care. A medically necessary escort adds $40 a day, except during an inpatient stay.
• No A0110, A0140, or A0170. Bus, air travel, and parking or tolls have no NEMT lines.

The ancillary codes entry shows how other states price meals, lodging, and escorts with the A0180 series.

What South Dakota Medicaid will not pay

Both manuals share a short non-covered list:

• Cancelled transportation, including no-shows.
• Trips to locations the manual does not allow, and anything not listed as covered.
• For community transportation, trips past the closest facility able to provide the care, unless the rider has written authorization from their local provider, primary care provider, or Health Home provider.
• For community transportation, trips from or to a “residence” that is a hospital, jail or detention center, medical campus, nursing facility, ICF/IID, or institution for mental disease.
• Community transportation claims from a nursing facility, since that transport is part of the facility’s routine costs.

Prescription, equipment, and optical pickups are covered only when delivery or mailing is not an option, although a first fill of a new prescription or an equipment fitting is covered even where delivery exists. For anything else, a provider can request an exception on the Transportation Exceptions Form, and the department approves only exceptions that save it money overall.

Claims, deadlines, and records

South Dakota takes transportation claims on the CMS-1500 or as an 837P. The manuals add three requirements:

1. List the origin and destination addresses on every claim. The community transportation manual puts them in Block 19 of the CMS-1500 or the equivalent 837P field.
2. Add every modifier that applies: TK, QM, TN, 59, and descriptive modifiers.
3. Get the claim to South Dakota Medicaid by the end of the sixth month following the service month (ARSD 67:16:35:04). Reconsideration requests must arrive before that deadline or no later than three months after the denial.

Hold records at least six years past the date a claim was last paid or denied. The department recommends its Transportation Documentation Form, which shows the rider was taken to a medical appointment, and secure providers should also document that the rider was confined to a wheelchair or needed a stretcher. Secure providers keep a longer list on file: verification dates for driver requirements, equipment statements, weekly safety inspection records with odometer readings, training records, vehicle and lift service records, insurance statements, accident records, and complaint logs. Each code on the schedule is a national HCPCS code, and the NEMT billing codes guide walks through them.

Invoicing South Dakota trips in HealthRide

South Dakota’s pay depends on details a claim has to prove: which miles were outside city limits, how many riders shared the van, and whether the hospital called the ride in. HealthRide’s driver app records GPS miles, timestamps, and signatures for every trip, and invoicing turns completed trips into invoices tied to one ledger, so each payment traces back to the trip it paid for.