20:06:27:01Definitions.

Terms used in this section mean: (1) "ASC Z12N standard format," the standards for electronic data interchange within the health care industry developed by the Accredited Standards Committee Z12N Insurance Subcommittee of the American National Standards Institute; (2) "CDT-2 codes," the current dental terminology prescribed by the American Dental Association; (3) "CPT-4 codes," codes for medical services and procedures performed by medical providers as listed in Physicians Current Procedural Terminology, (CPT '95) Fourth Edition, published by the American Medical Association; (4) "HCFA," the Health Care Financing Administration of the U.S. Department of Health and Human Services; (5) "HCFA Form 1450," the health insurance claim form maintained by HCFA for use by institutional care practitioners; (6) "HCFA Form 1500," the health insurance claim form maintained by HCFA for use by health care practitioners; (7) "HCPCS," HCFA's common procedure coding system which describes products, supplies, procedures, and health professional services; (8) "HCPCS Level 1 Codes," the AMA's CPT-4 codes and modifiers for professional services and procedures; (9) "HCPCS Level 2 Codes," alphanumeric codes and modifiers for health care products and supplies, as well as some codes for professional services not included in the AMA's CPT-4; (10) "HCPCS Level 3 Codes," local alphanumeric codes and modifiers for items and services not included in the HCPCS Level 1 or HCPCS Level 2; (11) "Health care practitioner," a provider of health care as follows: (a) A chiropractor licensed under SDCL chapter 36-5; (b) A corporation or partnership of health care practitioners listed in this subdivision; (c) A dentist licensed under SDCL chapter 36-6A; (d) A nurse licensed under SDCL chapter 36-9 or 36-9A; (e) An optometrist licensed under SDCL chapter 36-7; (f) A physician licensed under SDCL chapter 36-4; (g) A podiatrist licensed under SDCL chapter 36-8; (h) A psychologist licensed under SDCL chapter 36-27A; (i) A speech, physical, respiratory, or occupational therapist licensed under SDCL chapter 36-10 or 36-31; (j) A medical assistant licensed under SDCL chapter 36-9B; (k) A physician assistant licensed under SDCL chapter 36-4A; or (l) An emergency medical technician licensed under SDCL chapter 36-4B; (12) "ICD-9-CM codes," the diagnosis and procedure codes in the International Classification of Diseases, Ninth Revision, Clinical Modification published by the U.S. Department of Health and Human Services; (13) "Institutional care practitioner," a facility licensed under SDCL chapter 34-12 or listed in § 44:04:01:02; (14) "Issuer," an insurance company, fraternal benefit society, health care service plan, health maintenance organization, third party administrator, and any other entity reimbursing the costs of health care expenses; (15) "J512 form," the uniform dental claim form approved by the American Dental Association for use by dentists; (16) "Revenue codes," the codes established for use by institutional care practitioners by the National Uniform Billing Committee.

Source: 22 SDR 97, effective December 18, 1995.