MedicaidPrior AuthMedium impact
Attention Provider Types 14 (Behavioral Health Outpatient Treatment) and 82 (Behavioral Health Rehabilitative Treatment): Prior Authorization Requirement Updated for Procedure Code H0038
Nevada Medicaid·NV · Psychiatry·Prior Authorization
Effective date
Feb 26, 2025
We identified it
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.
Action Required
By February 26, 2025: Billing team must update systems to remove blanket prior authorization requirement for H0038 (Self-Help/Peer SVC per 15 min) for Nevada Medicaid patients. Configure system to track annual usage and require prior auth only after 72 units per calendar year. Update encounter forms for Provider Types 14 and 82. Claims exceeding 72 units without prior auth will deny with error code 5715.