MedicaidPrior AuthMedium impact
Error Codes 5612 and 5619 Updated for Current Procedural Terminology (CPT) Codes 92510–97761
Nevada Medicaid·NV · Physical Therapy, Occupational Therapy, Audiology +2 more·Billing & Coding
Effective date
Nov 25, 2024
We identified it
Jun 21, 2026
Summary
Nevada Medicaid updated error codes 5612 and 5619 that limit therapy encounters per year, removing restrictions from 11 specific therapy CPT codes and shifting encounter limits from therapy facilities to physician/provider types. Additionally, four cochlear implant codes no longer require prior authorization when billed by therapy providers.
Action Required
Immediately: Update billing system to reflect that error codes 5612 and 5619 (encounter limits) no longer apply to CPT codes 92510, 97124, 97533, 97033, 97034, 97036, 97113, 97530, 97542, 97760, and 97761. Configure system so encounter limits now apply to physicians (PT 20, 21, 24, 36, 74, 76, 77) instead of therapy facilities (PT 12, 17, 34) for specified therapy codes. Remove prior authorization requirements for cochlear implant codes 92601-92604 when billed by therapy providers (PT 34).