MedicaidPrior AuthMedium impact
Attention Provider Types 10 (Outpatient Surgery, Hospital Based), 12 (Hospital, Outpatient) and 46 (Ambulatory Surgical Centers, Freestanding): Clarification to Prior Authorization Requirements for Gender Dysphoria and Gender Incongruence Services
Nevada Medicaid·NV · General Surgery, Plastic Surgery, Urology +1 more·Prior Authorization
Effective date
Oct 15, 2024
We identified it
Jun 21, 2026
Summary
Nevada Medicaid clarified that prior authorization is NOT required for gender-specific procedure codes when the recipient's gender on file matches the gender for the procedure code being billed. Prior authorization IS still required when there's a gender mismatch (gender dysphoria/incongruence cases).
Action Required
Immediately: Billing team should review any pending gender-related prior authorization requests for Nevada Medicaid patients. Cancel PA requests where the recipient's gender on file matches the procedure code gender. Update billing workflows to only require PA for gender dysphoria/incongruence cases (gender mismatch). Reference Web Announcement 3416 for specific procedure codes requiring PA.