MedicaidReimbursementMedium impact
Updates Regarding Durable Medical Equipment (DME) Procedure Codes E0604 and E2512
Nevada Medicaid·NV · OB-GYN, Pediatrics·Provider Announcement
Effective date
Mar 10, 2025
We identified it
Jun 21, 2026
Summary
Nevada Medicaid has implemented service limits for hospital-grade electric breast pumps (E0604) effective March 10, 2025, with new error codes for exceeding 1 unit per month or 6 units per 6 months. Additionally, a new rental rate with RR modifier has been added for SGD accessory mounting systems (E2512).
Action Required
Immediately: Billing team must update Nevada Medicaid claims processing to enforce service limits for E0604 (1 unit per rolling month, 6 units per 6 rolling months) and expect error codes 5597 and 5739 for overages. Update fee schedule for E2512 with new RR modifier rental rate using EVS Search Fee Schedule feature. Train staff on new limits to prevent claim denials.