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Nevada MedicaidMedicaid · Prior Auth · Prior Authorization · NV · PsychiatryMedium impact

Attention Provider Types 14 (Behavioral Health Outpatient Treatment) and 82 (Behavioral Health Rehabilitative Treatment): Prior Authorization Requirement Updated for Procedure Code H0038

Act
by Feb 26, 2025
Effective date
Feb 26, 2025
Identified
Jun 21, 2026

Summary

Nevada Medicaid has relaxed prior authorization requirements for peer support services (H0038) for behavioral health providers. Prior authorization is now only required after exceeding 72 units per calendar year, rather than before any services are provided.

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What to do

by Feb 26, 2025 · 4 steps
01Billing team must update systems to remove blanket prior authorization requirement for H0038 (Self-Help/Peer SVC per 15 min) for Nevada Medicaid patients.
02Configure system to track annual usage and require prior auth only after 72 units per calendar year.
03Update encounter forms for Provider Types 14 and 82.
04Claims exceeding 72 units without prior auth will deny with error code 5715.

Codes mentioned

H0038

Original notice

Attention Provider Types 14 (Behavioral Health Outpatient Treatment) and 82 (Behavioral Health Rehabilitative Treatment): Prior Authorization Requirement Updated for Procedure Code H0038
medicaid.nv.gov · Always check the source before changing claims.
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Related changes

See all Nevada Medicaid changes →
Attention Provider Types 14 (Behavioral Health Outpatient Treatment) and 26 (Psychologist): Procedure Code H0038 Closed for Billing Effective February 26, 2027HighEffective Feb 26, 2027 · Billing & CodingAttention Provider Types 14 (Behavioral Health Outpatient Treatment), 82 (Behavioral Health Rehabilitative Treatment) and 93 (Substance Use Treatment) Linked to a Provider Type 93 Group: Behavioral Health Services Codes Open For BillingHighEffective Jul 1, 2024 · Billing & CodingAttention Behavioral Health Outpatient Providers: Rate Updates Effective January 1, 2025HighEffective Jan 1, 2025 · ReimbursementAttention Behavioral Health and Peer Support Service Providers: Service Limitation for Procedure Code H0038 Has Been UpdatedMediumEffective Feb 25, 2026 · Provider AnnouncementBrowse every Nevada Medicaid change in the policy list

Related policy hubs

Nevada Medicaid policiesNV policy changesPsychiatryCode H0038

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