South Dakota insurance law on MNT and nutrition counseling
The short answerSouth Dakota requires group health policies to cover diabetes self-management training and education, including medical nutrition therapy. A dietitian who meets the diabetes educator criteria may provide it. Coverage is limited to two full education programs per lifetime and eight follow-up visits per year.
By Javier Alvarez · Updated · 2 min read
1 row: State insurance law · South Dakota. Public policy, not the member's benefits.
South Dakota insurance law
Fully insured plans (S.D. Codified Laws 58-18-83) · South Dakota
| 97802 | Not published |
|---|---|
| 97803 | Not published |
| G0270 | Not published |
| G0271 | Not published |
| Where it applies | Every group health insurance policy delivered, issued for delivery, or renewed in South Dakota, except special disease or other limited benefit coverage. Medical nutrition therapy does not include any food items or nonprescription drugs. [1] |
| Diagnoses | Persons diagnosed with diabetes. [1] |
| Telehealth POS | Not published: call the payer. |
| Telehealth modifier | Not published: call the payer. |
| Visit limits | Limited to people newly diagnosed or with no prior diabetes education, people who need a change in therapy, people with a comorbid condition such as heart disease or renal failure, or people whose diabetes is unstable. No more than two full education programs per lifetime and up to eight follow-up visits per year need be covered. [1] |
| Referral and prior auth | Must be prescribed by a physician or other licensed health care provider legally authorized to prescribe the treatment. [1] |
| Who can bill | A physician, nurse, dietitian, pharmacist, or other licensed provider who meets the academic eligibility requirements of the National Certification Board for Diabetic Educators and has completed a diabetes education course or is a certified diabetes educator. The training must be based on an American Diabetes Association recognized program or one approved by the ADA or the South Dakota Department of Health. [1] |
What the South Dakota law says
- Where it applies. Every group health insurance policy delivered, issued for delivery, or renewed in South Dakota, except special disease or other limited benefit coverage. Medical nutrition therapy does not include any food items or nonprescription drugs.
- Diagnoses. Persons diagnosed with diabetes.
- Visit limits. Limited to people newly diagnosed or with no prior diabetes education, people who need a change in therapy, people with a comorbid condition such as heart disease or renal failure, or people whose diabetes is unstable. No more than two full education programs per lifetime and up to eight follow-up visits per year need be covered.
- Referral and prior auth. Must be prescribed by a physician or other licensed health care provider legally authorized to prescribe the treatment.
- Who can bill. A physician, nurse, dietitian, pharmacist, or other licensed provider who meets the academic eligibility requirements of the National Certification Board for Diabetic Educators and has completed a diabetes education course or is a certified diabetes educator. The training must be based on an American Diabetes Association recognized program or one approved by the ADA or the South Dakota Department of Health.
What it means for a claim in South Dakota
The law sets a floor for the plans it reaches; the plan's own policy and the member's contract still decide the codes, units and referral. On the benefits call, ask whether the plan is fully insured in South Dakota, and if a covered service is denied, name the statute by section in the appeal. The sources below link to the statute itself.
Payers with their own row for South Dakota: Wellmark and Medica. The state laws side by side compare South Dakota with other states.