MedicaidPrior AuthMedium impact
Attention Provider 14 (Behavioral Health Outpatient Treatment): Service Limitation Updated for Procedure Code H0002
Nevada Medicaid·NV · Psychiatry·Provider Announcement
Effective date
Mar 3, 2025
We identified it
Jun 21, 2026
Summary
Nevada Medicaid has implemented a service limitation for procedure code H0002 (Behavioral Health Screening) allowing only 1 service per 90 days for Behavioral Health Outpatient Treatment providers (PT 14). Claims exceeding this limit will deny with error code 5544 unless prior authorization is obtained.
Action Required
Immediately: Behavioral Health Outpatient Treatment providers (PT 14) must update billing systems to track H0002 usage and ensure only 1 claim per 90 days per patient. Obtain prior authorization before billing H0002 if within 90 days of previous service. Claims exceeding the limit will deny with error code 5544.