MedicaidPrior AuthMedium impact
Prior Authorization Requirements Updated for Gender Dysphoria Services
Nevada Medicaid·NV · Urology, Plastic Surgery, OB-GYN·Prior Authorization
Effective date
Dec 29, 2025
We identified it
Jun 21, 2026
Summary
Nevada Medicaid now requires prior authorization for specific gender dysphoria surgical procedures when billed with certain diagnosis codes (F64.0, F64.1, F64.2, F64.8, F64.9, or Z87.890). Six specific procedure codes are affected, and modifier KX or condition code 45 is still required for transgender patient claims.
Action Required
By December 29, 2025: Billing team must update system to require prior authorization for CPT codes 54308, 54312, 54326, 54328, 54360, and 56441 when billed with diagnosis codes F64.0, F64.1, F64.2, F64.8, F64.9, or Z87.890 for Nevada Medicaid patients. Ensure modifier KX or condition code 45 is still included for transgender patient claims. Claims without proper prior authorization will be denied.