MedicaidCoverageHigh impact
Updates to Limitation Error Codes
Nevada Medicaid·NV · Allergy & Immunology, Physical Therapy, Psychiatry +3 more·Provider Announcement
Effective date
Apr 28, 2025
We identified it
Jun 21, 2026
Summary
Nevada Medicaid has implemented new service limitation error codes and prior authorization requirements for multiple procedure codes effective April 28, 2025. Key changes include new unit limits for allergy testing and therapy codes, prior auth requirements for psychological testing, and restrictions on who can bill certain codes.
Action Required
Immediately: Update billing system with new unit limitations - CPT 95004 limited to 75 units per year, CPT 95165 to 12 units per year, CPT 97016/97032/97112 to 56 units per month with 4 per day max. Add prior authorization requirement for CPT 96138. Remove CPT 98960 billing capability for physician, APRN, midwife, and PA provider types. Update edits for CPT 97010-97124 to limit 4 modalities per day across all providers. Train staff on new error codes 5747, 5502, 5748, 5723, 5603, and 5749.