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Attention Provider Type 34 (Therapy) Specialties 29 (Speech Pathologist) and 219 (Speech Pathologist Language): Prior Authorization Requirements Removed for Certain Speech Therapy Services Effective January 1, 2026
Act
by Jan 1, 2026
Effective date
Jan 1, 2026
Identified
Jun 21, 2026
Summary
Nevada Medicaid is removing prior authorization requirements for certain speech therapy services effective January 1, 2026, but only for patients under age 26 with specific stutter diagnoses. Prior authorization will still be required for patients age 26 and older or without qualifying stutter diagnoses.
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What to do
by Jan 1, 2026 · 3 steps
01Speech therapy billing team must update prior authorization workflows in billing system to exempt patients under age 26 with stutter diagnoses (F80.81, F98.5, I69.023, R47.82) from PA requirements for the specified CPT codes.
02Update encounter forms and billing software rules to automatically check patient age and diagnosis before requiring prior authorization.
03Continue requiring PA for patients age 26+ or without qualifying stutter diagnoses.
Codes mentioned
F80.81F98.5I69.023R47.82925079250892520925269260592606926079260892609971299713097533
Original notice
Attention Provider Type 34 (Therapy) Specialties 29 (Speech Pathologist) and 219 (Speech Pathologist Language): Prior Authorization Requirements Removed for Certain Speech Therapy Services Effective January 1, 2026
medicaid.nv.gov · Always check the source before changing claims.
Related changes
See all Nevada Medicaid changes →Reminder to Provider Type 34 (Therapy) Specialties 29 (Speech Pathologist) and 219 (Speech Pathologist Language): Prior Authorization Requirements Removed for Certain Speech Therapy ServicesMediumEffective Jan 1, 2026 · Prior AuthorizationAttention Provider Type 60 (School Health Services): Ordering, Prescribing and Referring Requirements UpdatedMediumEffective Mar 9, 2026 · Provider EnrollmentAttention Provider Type 60 (School Health Services (SHS)): Claims for Procedure Codes 92507, 92508 and 92526 No Longer Deny with Error Code 5537MediumEffective Aug 26, 2024 · Provider EnrollmentAttention Provider Type 34 (Therapy) Specialties 027 (Physical Therapy) and 028 (Occupational Therapy): Update On Claims for Procedure Codes 97129, 97130, and 97533MediumEffective Feb 9, 2026 · Provider EnrollmentBrowse every Nevada Medicaid change in the policy list