Current fee-for-service (FFS) rates published by Dept of Social Services — Division of Medical Services for behavioral health codes. ABA therapy and psychotherapy codes, plus the E/M codes CMS requires in the Medicaid-vs-Medicare comparative analysis for outpatient mental health/SUD.
FFS benchmark rates only — managed care organization (MCO) contract rates may differ. Not legal or compliance advice.
| Code | Description | Variant | Rate | Effective | Status |
|---|---|---|---|---|---|
| 90791 | Initial psychiatric diagnostic evaluation without medical services. | — | $41.07 / encounter | 2026-06-01 | Auto-extracted |
| GT | $41.07 / encounter | 2026-06-01 | Auto-extracted | ||
| AM | $130.75 / encounter | 2026-06-01 | Auto-extracted | ||
| AM GT | $130.75 / encounter | 2026-06-01 | Auto-extracted | ||
| SA | $117.67 / encounter | 2026-06-01 | Auto-extracted | ||
| GT SA | $117.67 / encounter | 2026-06-01 | Auto-extracted | ||
| AM HB HE | $130.75 / encounter | 2026-06-01 | Auto-extracted | ||
| AM GT HB HE | $130.75 / encounter | 2026-06-01 | Auto-extracted | ||
| HB HE SA | $117.67 / encounter | 2026-06-01 | Auto-extracted | ||
| GT HB HE SA | $117.67 / encounter | 2026-06-01 | Auto-extracted | ||
| AM HE HK | $130.75 / encounter | 2026-06-01 | Auto-extracted | ||
| AM GT HE HK | $130.75 / encounter | 2026-06-01 | Auto-extracted | ||
| HE HK SA | $117.67 / encounter | 2026-06-01 | Auto-extracted | ||
| GT HE HK SA | $117.67 / encounter | 2026-06-01 | Auto-extracted | ||
| AM HE HW | $130.75 / encounter | 2026-06-01 | Auto-extracted | ||
| HE HW SA | $117.67 / encounter | 2026-06-01 | Auto-extracted | ||
| AM HA HE | $130.75 / encounter | 2026-06-01 | Auto-extracted | ||
| AM GT HA HE | $130.75 / encounter | 2026-06-01 | Auto-extracted | ||
| HA HE SA | $117.67 / encounter | 2026-06-01 | Auto-extracted | ||
| GT HA HE SA | $117.67 / encounter | 2026-06-01 | Auto-extracted | ||
| HA | $41.07 / encounter | 2026-06-01 | Auto-extracted |
Source: Dept of Social Services — Division of Medical Services
No. These are fee-for-service (FFS) benchmark rates published directly by South Dakota's Medicaid agency. Managed care organizations (MCOs) negotiate their own contract rates separately, and those aren't published publicly — FFS rates are commonly used as a reference point, not a guarantee of what an MCO will pay.
It varies by state and code — some update annually, others quarterly or on an as-needed basis. MedicaidBench checks official sources continuously and logs the effective date and source document for every rate change.
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