MedicaidPrior AuthMedium impact
Attention Provider Type 43 (Laboratory, Pathology Clinical): Procedure Codes 81206 and 81207 Open for Billing
Nevada Medicaid·NV · Pathology·Billing & Coding
Effective date
Nov 1, 2024
We identified it
Jun 21, 2026
Summary
Starting November 1, 2024, Nevada Medicaid will allow Laboratory/Pathology Clinical providers (Type 43) to bill procedure codes 81206 (BCR/ABL1 Gene Major BP) and 81207 (BCR/ABL1 Gene Minor BP), but both codes require prior authorization.
Action Required
By November 1, 2024: Laboratory and pathology billing teams must update billing systems to enable codes 81206 and 81207 for Nevada Medicaid claims and configure mandatory prior authorization requirements for both codes. Update encounter forms and laboratory order sets to remind staff that prior auth is required. Claims will be denied without proper prior authorization.