MedicaidPrior AuthMedium impact
COVID-19 UNWIND: COVID-19 Diagnostic and Serology Antibody Testing Update
Nevada Medicaid·NV · Family Medicine, Internal Medicine, Emergency Medicine +3 more·Provider Announcement
Effective date
Aug 1, 2025
We identified it
Jun 21, 2026
Summary
Nevada Medicaid is limiting COVID-19 diagnostic and serology antibody testing to two tests per recipient per month effective August 1, 2025. Additional testing beyond this limit will require prior authorization from providers.
Action Required
Immediately: Billing team must update system to track COVID-19 test frequency per Nevada Medicaid recipients and require prior authorization for codes 87635, 87636, 87637, and 87811 when exceeding two tests per month. Update encounter forms to alert providers of the monthly limit. Claims exceeding the limit without prior auth will be denied.