MedicaidCoverageMedium impact
Attention Provider Types 14 (Behavioral Health Outpatient Treatment) and PT 93 (Substance Use Treatment): Medically Necessary Services Provided by Intensive Outpatient Program (IOP) and Partial Hospitalization Program (PHP) Providers
Nevada Medicaid·NV · Psychiatry·Provider Announcement
Effective date
Nov 20, 2024
We identified it
Jun 21, 2026
Summary
Nevada Medicaid now allows IOP and PHP providers to coordinate and bill for additional medically necessary services outside of their daily rate structure. These additional services require prior authorization but are separately reimbursable when not included in the IOP/PHP treatment model.
Action Required
Immediately: IOP and PHP providers in Nevada must establish coordination procedures for additional medical services outside their program models. Update billing workflows to obtain prior authorization for these ancillary services following established Nevada Medicaid requirements. Train staff on documentation requirements to demonstrate medical necessity separate from IOP/PHP daily rates.