MedicaidCoverageMedium impact
Attention Provider Types 24 (Advanced Practice Registered Nurses) and 77 (Physician’s Assistant): Service Limitations Updated
Nevada Medicaid·NV · Allergy & Immunology, Physical Therapy, PM&R (Physical Medicine & Rehab)·Provider Announcement
Effective date
Nov 10, 2025
We identified it
Jun 21, 2026
Summary
Nevada Medicaid has implemented new service limitations for four CPT codes when billed by Advanced Practice Registered Nurses and Physician's Assistants. Claims exceeding these limits will be automatically denied with error codes, and no automatic reprocessing will occur.
Action Required
Immediately: Billing team must update billing software and provider alerts for Nevada Medicaid claims to track service limitations for APRNs and PAs: CPT 95004 limited to 75 units per rolling year, CPT 97016/97032/97112 limited to 56 units per rolling month with max 4 modalities per day. Train providers on new limits to prevent claim denials.