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Nevada MedicaidMedicaid · Prior Auth · Prior Authorization · NV · PsychiatryMedium impact

Attention Provider Types 14 (Behavioral Health Outpatient Treatment), 82 (Behavioral Health Rehabilitative Treatment) and 93 (Substance Use Treatment): Prior Authorization Updates to Behavioral Health Codes

Act
immediately
Effective date
Aug 1, 2025
Identified
Jun 21, 2026

Summary

Nevada Medicaid has implemented new prior authorization requirements for behavioral health codes H0015 and H0035 for specific provider types, and added PA override options for H0001 and H2011 codes when service limitations are exceeded. These changes only affect behavioral health providers linked to substance use treatment groups.

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What to do

immediately · 3 steps
01Billing teams at behavioral health practices (provider types 14, 82, and 93) must update billing systems to require prior authorization for H0015 and H0035 when billed by QMHP specialty 300 providers.
02Configure systems to request PA for H0001 when exceeding 1 unit per 90 days and H2011 when exceeding 16 units per day for applicable specialties.
03Claims without required PA will be denied with specific error codes.

Codes mentioned

H0015H0035H0001H2011

Original notice

Attention Provider Types 14 (Behavioral Health Outpatient Treatment), 82 (Behavioral Health Rehabilitative Treatment) and 93 (Substance Use Treatment): Prior Authorization Updates to Behavioral Health Codes
medicaid.nv.gov · Always check the source before changing claims.
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Related changes

See all Nevada Medicaid changes →
Attention Provider Types 14 (Behavioral Health Outpatient Treatment), 82 (Behavioral Health Rehabilitative Treatment) and 93 (Substance Use Treatment) Linked to a Provider Type 93 Group: Behavioral Health Services Codes Open For BillingHighEffective Jul 1, 2024 · Billing & CodingFurther Clarification of Certain Billing Procedures for Substance Use Treatment ServicesHighEffective Sep 11, 2026 · Billing & CodingCrisis Intervention Service Claims That Denied With Error Code 5695 Have Been ReprocessedMediumEffective Apr 23, 2025 · Provider AnnouncementRate Updates Implemented for Procedure Codes H0035 and H2012MediumEffective Jul 1, 2025 · ReimbursementBrowse every Nevada Medicaid change in the policy list

Related policy hubs

Nevada Medicaid policiesNV policy changesPsychiatryCode H0015Code H0035Code H0001Code H2011

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