MedicaidBilling CodesHigh impact
Attention Provider Type 20 (Physician, M.D., Osteopath, D.O.): Billing Instructions for Inpatient Hospital Care Including Critical Care
Nevada Medicaid·NV · Internal Medicine, Family Medicine, General Practice +1 more·Billing & Coding
Effective date
Feb 25, 2026
We identified it
Jun 21, 2026
Summary
Nevada Medicaid now prohibits multiple physicians from the same billing group and specialty from billing consultation codes (99252-99255) or inpatient visit codes (99221-99223, 99231-99233) for the same patient on the same day. Instead, they must use critical care codes (99291-99292) only when critical care is medically necessary.
Action Required
Before February 25, 2026: Billing team must update Nevada Medicaid billing rules to prevent multiple physicians from same group/specialty billing consultation codes (99252-99255) or inpatient visit codes (99221-99223, 99231-99233) for same patient on same day. Configure system to allow only critical care codes (99291-99292) when multiple same-specialty providers see patient same day and critical care is documented. Train providers on new restrictions to avoid error code 5081 denials.