MedicaidPrior AuthMedium impact
Updates to Prior Authorization Requirements for Various Procedure Codes
Nevada Medicaid·NV · Ophthalmology, Oral & Maxillofacial Surgery, Dermatology +5 more·Prior Authorization
Effective date
Dec 1, 2025
We identified it
Jun 21, 2026
Summary
Nevada Medicaid has removed prior authorization requirements for 13 procedure codes effective December 1, 2025, when billed by specific provider types. This simplifies the billing process for procedures including cataract surgery, skin lesion destruction, facial bone procedures, and various unlisted procedures.
Action Required
By December 1, 2025: Billing team must update Nevada Medicaid billing workflows to remove prior authorization requirements for the 13 specified procedure codes when billed by applicable provider types. Update billing software rules and staff training materials to reflect that these procedures no longer require PA approval, allowing for faster claim submission and processing.