MedicaidPrior AuthMedium impact
Prior Authorization Requirements Updated for Procedure Code 90901
Nevada Medicaid·NV · Psychiatry, PM&R (Physical Medicine & Rehab), Pain Management·Prior Authorization
Effective date
Oct 13, 2025
We identified it
Jun 21, 2026
Summary
Nevada Medicaid now requires prior authorization for biofeedback training (CPT 90901) when exceeding 6 units per rolling month for specific provider types including hospitals, physicians, psychologists, and others. Claims exceeding this limit without approved PA will be denied with error code 5555.
Action Required
Immediately: Billing team must update system to track CPT 90901 units per rolling month for Nevada Medicaid patients. Require prior authorization using Form FA-11 (Behavioral Health Outpatient or Rehabilitative Authorization Request) with process type 'BH Outpatient' before submitting claims that exceed 6 units per month. Update encounter forms to alert providers of the 6-unit monthly limit. Claims exceeding the limit without approved PA will deny with error code 5555.