MedicaidAdministrativeHigh impact
Attention All Providers: Professional and Institutional Claims That Paid in Error Have Been Reprocessed
Nevada Medicaid·NV · Physical Therapy, Occupational Therapy·Provider Announcement
Effective date
Aug 23, 2024
We identified it
Jun 21, 2026
Summary
Nevada Medicaid automatically reprocessed claims for physical therapy and occupational therapy evaluation codes (97161-97167) that incorrectly paid when duplicate evaluations were billed in the same calendar year. These claims were denied with error code 6104 for dates of service February 1, 2019 through May 7, 2024.
Action Required
By August 23, 2024: Review remittance advice dated August 23, 2024 for reprocessed PT/OT evaluation claims. Identify any claims now denied with error code 6104 (Evaluation Previously Paid for Calendar Year). Verify billing practices to ensure only one evaluation per therapy type per calendar year is submitted. If appropriate, prepare appeals for denied claims following Medicaid Services Manual Chapter 100 guidelines.