MedicaidBilling CodesMedium impact
Attention Provider Type 60 (School Health Services): Service Limitations Added for Procedure Codes 99401, 99402, 99403, and 99404
Nevada Medicaid·NV · Pediatrics, Family Medicine·Provider Enrollment
Effective date
Aug 1, 2024
We identified it
Jun 21, 2026
Summary
Nevada Medicaid has implemented service limitations for preventive medicine counseling codes 99401-99404 for School Health Services providers (Type 60), limiting these codes to 1 unit per day effective August 1, 2024. Claims exceeding this limit will be denied with error code 5537, and previously paid claims that exceeded the limit will be automatically reprocessed.
Action Required
For Nevada School Health Services providers only: Billing team must update system rules to limit CPT codes 99401, 99402, 99403, and 99404 to maximum 1 unit per day for Medicaid claims. Monitor remittance advices for reprocessed claims that previously exceeded these limits. Claims exceeding limits will deny with error code 5537.