The Department of Social Services Billing and Policy Manual for Applied Behavior Analysis was read in full; each page header prints "UPDATED December 25," read here as December 2025 (South Dakota Medicaid Billing and Policy Manual: Applied Behavior Analysis). The manual gives no state plan amendment number. The ABA fee schedule could not be retrieved, because the Department's index page lists none and both ABA schedule paths tried returned HTTP 404.
South Dakota Medicaid says BCaBAs and RBTs are not eligible to enroll. Their services bill under a licensed, enrolled supervising behavior analyst, and only for the technician codes. A practice without an enrolled behavior analyst has no way to bill technician time.
The reimbursement criteria at a glance
- Is ABA covered by South Dakota Medicaid
- Who is eligible and who orders
- Billing and rates
- Place of service and telemedicine
- Prior authorization
- Provider qualifications and enrollment
- The commercial mandate
- Practices with in-house diagnostics versus ABA-only practices
- How this connects to the rest of your compliance stack
- What this guide could not verify
- South Dakota reimbursement variables at a glance
- Frequently asked questions
- Where professional advice is essential
Is ABA covered by South Dakota Medicaid
Yes. "Applied Behavior Analysis (ABA) Therapy services are available under the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit for children 20 years old or younger with an Autism Spectrum Disorder (ASD) diagnosis from a physician or psychologist" (South Dakota Medicaid ABA manual).
Who is eligible and who orders
"ABA services must be ordered by a physician, nurse practitioner, or physician assistant. If the recipient is participating in Care Management program the ordering provider must be their Care Management provider. The diagnosis must be within 12 months prior to the start of services." The prior authorization request needs medical records showing an ASD diagnosis within the previous 12 months by a physician or psychologist, including "the name of the evidence-based diagnosis evaluation instrument." Coverage applies to Medicaid and CHIP full coverage (South Dakota Medicaid ABA manual).
Billing and rates
The covered codes are "Behavior Identification Assessment (CPT 97151, 97152)" and "Adaptive Behavior Treatment (CPT 97153, 97154, 97155, 97156, 97157, 97158)." Payment "is limited to the lesser of the provider's usual and customary charge or the fee contained on South Dakota Medicaid's Applied Behavior Analysis fee schedule." Services by a BCaBA or RBT "must be billed under the supervising, licensed, and enrolled behavior analyst and may only be billed for the technician specific codes (CPT codes 97152-97154)" (South Dakota Medicaid ABA manual). No per-unit rate was retrieved.
Place of service and telemedicine
"ABA services may be provided via telemedicine," by a real-time interactive telecommunications system, and the BCBA "must have an in-person face-to-face visit within the first 30 days and every 90 days thereafter." "ABA services may not be provided by school district providers. However, an eligible ABA provider may provide services in a school district setting." Not covered are services rendered by the parent or guardian, services "in a non-conventional setting including but not limited to resorts, spas and camps," and the provider's travel time (South Dakota Medicaid ABA manual).
Prior authorization
"Services must be prior authorized by South Dakota Medicaid prior to being provided. Prior authorizations for ABA treatment are for a period of 6 months. A re-authorization for services must be obtained after 6 months." The request includes the "clinical recommendation of the amount of weekly services necessary by service code" (South Dakota Medicaid ABA manual). The manual sets no hour limit, and the role of managed care was not verified.
Provider qualifications and enrollment
ABA services may be billed by licensed and enrolled physicians, psychologists, and behavior analysts. "Technician services may be provided by a Board-Certified Assistant Behavior Analyst (BCaBA) or a Registered Behavior Technician (RBT) certificated by the Behavior Analyst Certification Board when supervised by a licensed and enrolled behavior analyst. BCaBAs and RBTs are not eligible to enroll in South Dakota Medicaid." All servicing and billing providers must have their NPIs enrolled (South Dakota Medicaid ABA manual). See the South Dakota Licensing page.
The commercial mandate
Commercial ABA coverage provisions sit at SDCL 58-17-154 to 58-17-162, the citation range printed in a 2017 House bill amending them (South Dakota HB 1195 (2017), introduced text). Whether that bill was enacted, and the current age and dollar limits, were not verified, because the codified text on the Legislature's site did not load.
Practices with in-house diagnostics versus ABA-only practices
Physicians and psychologists can bill ABA, and a psychologist can diagnose, so a practice with in-house diagnostics can combine the diagnosis with treatment under one enrolled provider. An ABA-only practice needs an outside physician, nurse practitioner, or physician assistant to order services and an outside physician or psychologist to diagnose.
How this connects to the rest of your compliance stack
See the South Dakota Licensing page for the credential posture and the South Dakota entity page for the structure analysis.
What this guide could not verify
- Per-unit rates for 97151 to 97158.
- Hour limits and any managed care role.
- The current text, age cap, and dollar cap of SDCL 58-17-154 to 58-17-162.
- The state plan amendment authority for the benefit.
South Dakota reimbursement variables at a glance
| Variable | South Dakota value |
|---|---|
| ABA covered by Medicaid? | Yes, EPSDT, children 20 or younger with ASD |
| Ordering provider | Physician, nurse practitioner, or physician assistant |
| Prior authorization | 6 month periods |
| BCaBA and RBT enrollment | Not eligible to enroll; bill under supervising behavior analyst |
| Rates | Not verified |
Frequently asked questions
Can an RBT enroll in South Dakota Medicaid?
Is telemedicine allowed?
How long does an authorization last?
Where professional advice is essential, not optional
South Dakota's manual is clear on structure but the fee schedule was not reachable, so confirm rates before modeling. Plan your staffing around the rule that only enrolled behavior analysts can bill.
The governing authorities to know are the DSS ABA Billing and Policy Manual and SDCL 58-17-154 to 58-17-162.
This page describes rules read from the South Dakota Department of Social Services manual. The fee schedule and the codified commercial statute could not be read. The Department, the Division of Insurance, and each payor provide current requirements. Do not rely on this page or any secondary source in place of direct verification.