MedicaidPrior AuthMedium impact
Attention Provider Types 10 (Outpatient Surgery, Hospital Based), 12 (Hospital, Outpatient) and 46 (Ambulatory Surgical Centers, Freestanding): Additional Coverage for Gender Dysphoria and Gender Incongruence
Nevada Medicaid·NV · General Surgery, Plastic Surgery, Urology +1 more·Provider Announcement
Effective date
Sep 1, 2024
We identified it
Jun 21, 2026
Summary
Nevada Medicaid now covers gender dysphoria and gender incongruence procedures for specific provider types, with prior authorization required starting September 1, 2024. Previously denied claims with specific error codes will be automatically reprocessed.
Action Required
By September 1, 2024: Update billing system to require prior authorization for 71 specific gender dysphoria/incongruence procedure codes when billed by provider types 10, 12, and 46. Continue using modifier KX or condition code 45 for transgender patient claims. Claims without prior auth will deny with error code 3001.