MedicaidPrior AuthMedium 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
Nevada Medicaid·NV · Psychiatry·Prior Authorization
Effective date
Aug 1, 2025
We identified it
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.
Action Required
Immediately: Billing 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. Configure systems to request PA for H0001 when exceeding 1 unit per 90 days and H2011 when exceeding 16 units per day for applicable specialties. Claims without required PA will be denied with specific error codes.