MedicaidCoverageMedium impact
Attention Behavioral Health and Peer Support Service Providers: Service Limitation for Procedure Code H0038 Has Been Updated
Nevada Medicaid·NV · Psychiatry·Provider Announcement
Effective date
Feb 25, 2026
We identified it
Jun 21, 2026
Summary
Nevada Medicaid increased the annual service limitation for procedure code H0038 (peer support services) from 72 units to 208 units per calendar year, effective February 25, 2026. Claims exceeding this limit will require prior authorization or be denied with error code 5752.
Action Required
Immediately: Billing team must update system settings to reflect new 208-unit annual limit for H0038 and all its modifiers (HQ, HR, HS, HA combinations). Update prior authorization workflows to trigger at 208 units instead of 72 units. Monitor for automatic reprocessing of previously denied claims with error code 5715 on future remittance advice.