MedicaidPrior AuthMedium impact
Attention Providers Who Bill Procedure Code 95165: Service Limitation Has Been Updated
Nevada Medicaid·NV · Allergy & Immunology·Provider Announcement
Effective date
Apr 28, 2025
We identified it
Jun 21, 2026
Summary
Nevada Medicaid has updated the service limitation for CPT code 95165 (Antigen Therapy Services) to 120 units per rolling year. Claims exceeding this limit will be denied unless prior authorization is obtained, with different effective dates for different provider types.
Action Required
Immediately: Billing team must update system to track CPT 95165 units per rolling year and flag when approaching 120 units. Configure system to require prior authorization for any claims exceeding 120 units annually for Nevada Medicaid patients. Claims exceeding the limit without prior authorization will deny with error code 5750. Update billing workflows to monitor unit usage throughout the year.