MedicaidPrior AuthMedium impact
Attention Provider Type 85 (Applied Behavior Analysis (ABA)): Reminder of Limitations for Adaptive Behavior Treatment for Individuals
Nevada Medicaid·NV · Psychiatry·Provider Enrollment
We identified it
Jun 21, 2026
Summary
Nevada Medicaid is reminding ABA providers of existing hour limits for prior authorization: Focused ABA services are limited to 15-25 hours per week, and Comprehensive ABA services are limited to 25-40 hours per week. Providers can request authorization to exceed these limits with documentation of medical necessity.
Action Required
Immediately: ABA providers must ensure weekly service hours comply with Nevada Medicaid limits - 15-25 hours for Focused delivery (CPT 97153, 97155, 0373T) and 25-40 hours for Comprehensive delivery. Submit prior authorization requests with medical necessity documentation for cases requiring hours above these limits. Review current patient schedules to ensure compliance.