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MedicaidAdministrativeMedium impact

Attention Provider Type 60 (School Health Services): Ordering, Prescribing and Referring Requirements Updated

Nevada Medicaid·NV · Audiology, Physical Therapy, Speech Therapy·Provider Enrollment
Effective date
Mar 9, 2026
We identified it
Jun 21, 2026
Days to comply
—

Summary

Nevada Medicaid updated ordering, prescribing and referring (OPR) provider requirements for School Health Services providers. Effective March 9, 2026, specific procedure codes will require the ordering provider's NPI on claims or they will be denied, while some codes no longer require OPR provider NPIs as of July 1, 2024.

Action Required

Action needed
Before March 9, 2026: Billing team must update Nevada Medicaid claims for Provider Type 60 (School Health Services) to include ordering provider NPI for codes 80305, 80306, 80307, 86328, 87426, 87428, 87636, 87637, 87811, 87635, 92507, 92508, 92605-92609, 97010, 97161-97167, 97763, A4287, B4148, E0602, E0603, 99366/99368 with modifier TD, and H0034 with modifier TD. Ensure the NPI belongs to an individual provider who is authorized and active in Nevada Medicaid. Claims without required NPIs will be denied with error codes 1022 or 1027.

Affected Billing Codes

80305
80306
80307
86328
87426
87428
87636
87637
87811
87635
92507
92508
92605
92606
92607
92608
92609
97010
97161
97162
97163
97165
97166
97167
97763
A4287
B4148
E0602
E0603
99366
99368
H0034
92524
92601
92602
92603
92604
92626
92627
A5200
G0515
K0552
Q3014

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