MedicaidPrior AuthMedium impact
Prior Authorization Required for Skin Substitute Procedure Codes (Updated December 17, 2024)
Nevada Medicaid·NV · Wound Care, Plastic Surgery, General Surgery +1 more·Prior Authorization
Effective date
Aug 28, 2024
We identified it
Jun 21, 2026
Summary
Nevada Medicaid now requires prior authorization for three skin substitute procedure codes (Q4133, Q4186, Q4101) effective August 28, 2024. Providers must submit a signed wound care treatment plan or letter of medical necessity dated within 30 days of the procedure, with extended deadlines for submitting PAs for services performed through December 31, 2024.
Action Required
By February 28, 2025 (in-state) or August 28, 2025 (out-of-state): Billing team must obtain prior authorization for codes Q4133, Q4186, and Q4101 before performing procedures. Providers must prepare signed and dated wound care treatment plans or letters of medical necessity within 30 days of procedure date, including planned interventions, treatment goals, and expected outcomes. Update billing system to flag these codes for prior auth requirements. Claims may be denied without proper authorization and documentation.