South Dakota Telemedicine Laws: License, Consent, Parity

South Dakota writes its telehealth practice rules in one short chapter, SDCL 34-52, which applies to every licensed health care professional. It requires South Dakota licensure or employment by a listed facility (a condition, not an exemption from any profession's licensing law), spells out an eight-part provider-patient relationship, and bars prescribing controlled substances solely from an internet questionnaire or telephone consult without that relationship. The insurance code, SDCL 58-17-167 to 58-17-170, requires coverage parity for audio-video care and stops there. Medicaid covers audio-only for listed services, generally only when the recipient cannot use video. For how state rules interact in general, see how state telemedicine laws work.

Licensure: a South Dakota license, and an employment clause that is not an exemption

SDCL 34-52-2 says any health care professional "treating a patient in the state through telehealth" must be "fully licensed to practice in the state or employed by a licensed health care facility, an accredited prevention or treatment facility, a community support provider, a nonprofit mental health center, or a licensed child welfare agency under § 36-32-76," and subject to any rule of the applicable South Dakota licensing body. "Health care professional" borrows the insurance code's definition in SDCL 58-17F-1: a physician or other practitioner licensed, accredited, or certified to perform specified health services. Section 34-52-2 lists conditions a telehealth professional must meet; it does not grant permission to practice or exempt anyone from a profession's own licensing law. For physicians, SDCL 36-4-24.3 excuses only those "specifically excepted from the provisions of this chapter," and section 34-52-2 sits in a different chapter, so a physician employed by a listed facility still needs a South Dakota license or an exception under chapter 36-4. Other professions should check their own licensing statute before relying on the employment clause.

For physicians, that practice act is criminal. Under SDCL 36-4-8, practicing medicine or osteopathy without a license, certificate, or permit issued by the board is a Class 1 misdemeanor, and SDCL 36-4-24.3 separately makes practicing without an active license a Class 1 misdemeanor. SDCL 36-4-39 lists five situations in which a physician holding a "permanent, unrestricted license" in another state, a U.S. territory, the District of Columbia, or a Canadian province needs no South Dakota license, including "one time consultation or teaching assistance for no more than twenty-four hours." SDCL 36-2-9 says chapter 36-2 does not apply to a licensed person practicing outside the state "when in actual consultation with a licensed practitioner of the healing arts in this state," and SDCL 34-52-2 routes resident-to-nonresident consultation through that section. Neither exception covers ongoing direct care of a South Dakota patient.

Compacts are the main shortcut. South Dakota is a full Interstate Medical Licensure Compact member under SB 63 (2015), codified at SDCL 36-4-44, with a statutory effective date of July 1, 2015. It has issued Nurse Licensure Compact multistate licenses since January 19, 2018, and is a full Physical Therapy Compact member. PSYPACT is pending: H 1017 was enacted February 13, 2024, with a July 1, 2024 effective date, but PSYPACT still lists South Dakota as enacted and not yet effective. Counseling Compact membership is also pending. See the cross-state licensing tracker.

Prescribing: a relationship first, and no controlled substances from a questionnaire or phone call alone

SDCL 34-52-3 requires any professional using telehealth to establish a proper provider-patient relationship with eight elements: verifying and authenticating the patient's location and, to the extent reasonable, identity; disclosing and validating the professional's identity and credentials, as appropriate; obtaining appropriate consent; establishing a diagnosis through acceptable medical practices, "including patient history, mental status examination, physical examination, and appropriate diagnostic and laboratory testing"; discussing the diagnosis, its evidentiary basis, and treatment risks and benefits; ensuring appropriate follow-up care; providing a visit summary or consult note; and using technology sufficient to evaluate, diagnose, and treat under the applicable standard of care. The statute's exceptions "include" on-call and cross-coverage situations and consultation with another professional who has an ongoing relationship with the patient and agrees to supervise the patient's care and emergency treatment.

SDCL 34-52-5 adds an examination rule: a professional using telehealth to provide medical care to a patient located in the state must provide an appropriate face-to-face examination using real-time audio and visual technology before diagnosis and treatment, "if a face-to-face encounter would otherwise be required" for the same service delivered in person.

SDCL 34-52-6 is the controlled-substance limit. Without a proper provider-patient relationship, a professional using telehealth "may not prescribe a controlled drug or substance, as defined by § 34-20B-3, solely in response to an internet questionnaire or consult, including any encounter via telephone." Section 34-20B-3 defines that term as Schedules I through IV.

Two other state duties sit around it. SDCL 34-20E-2.1 requires anyone holding a state controlled-substance registration to prescribe or dispense in South Dakota to register with the prescription drug monitoring program; veterinarians are exempt. For physicians treating chronic non-cancer pain with controlled substances, ARSD 20:47:07:01 requires the record to include, among thirteen items, confirmation that the appropriate state monitoring programs were accessed and the date, "or an explanation why they were not accessed," plus signed informed consent and any treatment agreement. We found no state mandate for electronic prescribing of controlled substances in SDCL chapter 34-20B. Medicare Part D separately requires at least 70 percent of Part D Schedule II–V prescriptions to be electronic under 42 CFR 423.160, subject to exceptions and waivers.

Federal law adds a separate layer for controlled substances. Under the temporary rule DEA and HHS published December 31, 2025 (90 FR 61301), which runs through December 31, 2026, a DEA-registered practitioner may prescribe Schedule II–V controlled substances after a real-time audio-video telemedicine encounter without a prior in-person evaluation, when the rule's other conditions are met; audio-only encounters qualify only for Schedule III–V narcotic medications approved by the FDA to treat opioid use disorder. See our guide to federal telehealth laws.

Consent: required by the relationship statute, form left open

SDCL 34-52-3(3) requires "obtaining appropriate consent for treatment from a requesting patient after disclosure regarding the delivery models and treatment methods or limitations." SDCL 34-52-7 adds that a professional using telehealth "shall follow any applicable state or federal statute or rule for informed consent." Neither section prescribes written or verbal form. SDCL 34-52-8 requires the professional or originating site to keep a complete record, disclose it to the patient consistent with state and federal law, and follow retention and confidentiality rules. In Medicaid, the provider must obtain the recipient's consent to furnish remote patient monitoring.

Medicaid: in-person rates, video by default

The Telemedicine Services chapter of the South Dakota Medicaid Billing and Policy Manual sets the rules. Telemedicine services carry the same requirements and limitations as in-person services, and the maximum allowable amount is the same as in person. Only procedure codes marked allowable on the Procedure Look-Up Tool, or on community mental health center (CMHC) and substance use disorder (SUD) agency fee schedules, are covered. Any U.S. location, including the home, can be an originating site, though only listed facilities earn the originating-site fee. To be paid, a distant-site practitioner must be licensed in both the originating-site and distant-site states and bill the GT modifier, with place of service 02, 10 for the home, or 77 for audio-only; audio-only claims from providers other than CMHCs and SUD agencies use modifier 93. Store-and-forward is generally not covered except radiology. Physical, occupational, and speech therapy by telemedicine require a face-to-face visit within the first 30 days and every 90 days thereafter. Remote patient monitoring is covered for listed conditions.

Audio-only is covered in two main categories. Behavioral health services from SUD agencies, CMHCs, and independent mental health practitioners are covered for listed codes when the recipient lacks access to audio-video technology; audio-only is not covered for provider or recipient convenience, and the record must show video "was not possible or was unsuccessful." Audio-only evaluation and management is covered for established patients who lack video access, only by a physician, podiatrist, nurse practitioner, physician assistant, or optometrist, for 10 minutes or longer, and not on the same day as an in-person E/M. Doula and community health worker services, school-district psychology, and targeted case management for justice-involved youth carry their own audio-only allowances.

Private insurance: coverage parity, with negotiable payment

SDCL 58-17-168 bars a health insurer from excluding a service "solely because the service is provided through telehealth." Telehealth here means HIPAA-compliant interactive audio-video; the definition in SDCL 58-17-167 excludes audio-only telephone, email, text, mail, and fax. Insurers need not cover services that are not medically necessary. The section also lets insurers set criteria for delivering a service by telehealth they do not already reimburse, and require documentation or billing practices against fraud, so long as neither is "unduly burdensome or unreasonable." Deductibles, copayments, and coinsurance may not be in addition to or exceed the in-person amounts.

SDCL 58-17-169 bars discrimination "between coverage benefits" for in-person and telehealth services appropriate for telehealth, then preserves contracts "with terms subject to negotiation." It sets no payment rate. Under SDCL 58-17-170 the rules apply to individual and group policies delivered, issued, or renewed in South Dakota on or after January 1, 2020, excluding fourteen kinds of limited coverage, among them specified disease, hospital indemnity, Medicare supplement, and non-renewable individual plans of six months or less. No sunset appears. Self-funded employer plans governed by federal ERISA law are generally outside state insurance mandates like this one. See our reimbursement guide.

What to watch

Three items. First, abortion medication. Under SDCL 22-17-5.1, anyone who prescribes, procures, or administers any drug with intent to procure an abortion commits a Class 6 felony unless appropriate and reasonable medical judgment finds an abortion necessary to preserve the pregnant female's life; prescribing by telehealth or sending pills by mail does not change that. Someone who practices medicine without a South Dakota board license and prescribes to induce a medical abortion commits a Class 6 felony under SDCL 36-4-8. HB 1274, signed March 20, 2026 (SL 2026, ch 100, codified at SDCL 22-17-5.3 to 22-17-5.5), adds a Class 6 felony for knowingly dispensing, distributing, selling, or advertising abortion-producing articles for an unlawful abortion, plus attorney general civil penalties and injunctions. Under SDCL 22-17-5.2, the woman who undergoes the abortion may not be held criminally liable. Second, HB 1146, signed March 9, 2026, adopts the Physician Assistant Licensure Compact; confirm when privileges begin. Third, PSYPACT and Counseling Compact status. Confirm current requirements with the Board of Medical and Osteopathic Examiners and South Dakota Medicaid.