MedicaidPrior AuthMedium impact
Attention Provider Types 11 (Hospital, Inpatient), 12 (Hospital, Outpatient), and 20 (Physician, M.D., Osteopath, D.O.): Billing Guides Updated
Nevada Medicaid·NV · Transplant Surgery, General Surgery·Billing & Coding
Effective date
Apr 18, 2025
We identified it
Jun 21, 2026
Summary
Nevada Medicaid has updated billing guides for hospitals and physicians to include new prior authorization requirements for transplant procedures. Authorization must be requested when patients are placed on wait lists and again for inpatient stays.
Action Required
Effective April 18, 2025: Billing teams for Nevada Medicaid providers must implement new transplant prior authorization workflow. Submit outpatient medical/surgical authorization requests immediately when recipients are placed on transplant wait lists, including PT 12 or 20 as rendering provider and transplant CPT code with 365-day service dates. Submit separate inpatient authorization requests when organ becomes available and patient is admitted. Review updated billing guides on Nevada Medicaid Provider website.