MedicaidPrior AuthMedium impact
Attention Provider Type 46 (Ambulatory Surgical Centers): Prior Authorization Required for Skin Substitute Procedure Codes
Nevada Medicaid·NV · Wound Care, General Surgery, Plastic Surgery·Prior Authorization
Effective date
Aug 28, 2024
We identified it
Jun 21, 2026
Summary
Nevada Medicaid now requires prior authorization for three specific skin substitute procedure codes (Q4133, Q4186, Q4101) when performed at Ambulatory Surgical Centers. Providers must submit a signed wound care treatment plan or letter of medical necessity dated within 30 days of the procedure.
Action Required
By February 28, 2025 (in-state) or August 28, 2025 (out-of-state): Billing team must update system to require prior authorization for codes Q4133, Q4186, and Q4101 at Ambulatory Surgical Centers. Providers must submit signed wound care treatment plan or letter of medical necessity within 30 days of procedure date. Contact medicalprograms@dhcfp.nv.gov for questions. Claims may be denied without proper prior authorization.