MedicaidPrior AuthHigh impact
Invoice Requirements for Durable Medical Equipment (DME) With No Rate Assigned at Prior Authorization
Nevada Medicaid·NV · PM&R (Physical Medicine & Rehab), Orthopedics, Neurology·Prior Authorization
Effective date
Mar 21, 2025
We identified it
Jun 21, 2026
Summary
Nevada Medicaid now requires detailed manufacturer invoices/quotes for DME items without assigned rates at prior authorization. Reimbursement will be the lowest of MSRP less 25%, acquisition cost plus 20%, or actual charge, with specific invoice requirements including HCPCS codes and timing restrictions.
Action Required
Immediately: DME providers must update prior authorization submission processes to include detailed manufacturer invoices/quotes with itemized MSRP or acquisition costs, manufacturer name/address, recipient name, invoice number/date, HCPCS codes, and provider NPI. Ensure invoices are no more than 180 days old from service date and delivery dates don't exceed service dates. Train staff that incomplete documentation will result in PA denials or SURS referrals.