MedicaidPrior AuthHigh impact
Attention All Providers: Drug-Related Procedure Codes Open for Billing
Nevada Medicaid·NV · Pharmacy, Oncology, Allergy & Immunology +1 more·Pharmacy
Effective date
Dec 1, 2024
We identified it
Jun 21, 2026
Summary
Nevada Medicaid has made numerous previously non-covered drug-related procedure codes billable with various retroactive effective dates, and will require prior authorization for four specific injection codes starting December 1, 2024. Denied claims for the newly covered codes will be automatically reprocessed.
Action Required
By December 1, 2024: Billing team must update Nevada Medicaid billing system to require prior authorization for codes Q5127, Q5128, Q5129, and Q5130. Update encounter forms to alert providers that these injection codes need PA. Claims submitted without prior auth will be denied with error code 3001. Review remittance advice messages for details on automatically reprocessed claims for newly covered codes.