MedicaidAdministrativeMedium impact
Attention Provider Type (PT) 85 (Applied Behavior Analysis) Providers: Instructions for Claim Submission When ABA Services are Rendered in a Psychiatric Hospital (PT 13) or a Residential Treatment Center (PT 63)
Nevada Medicaid·NV · Psychiatry, Pediatrics·Billing & Coding
Effective date
May 1, 2024
We identified it
Jun 21, 2026
Summary
Nevada Medicaid now allows ABA providers to resubmit previously denied claims (error codes 5003/5004) when services were rendered in psychiatric hospitals or residential treatment centers. Claims must include an attachment referencing this web announcement to bypass system edits.
Action Required
Immediately: Billing team should resubmit any ABA claims denied with error codes 5003 or 5004 since May 1, 2024, when services were rendered in psychiatric hospitals (PT 13) or residential treatment centers (PT 63). Include attachment referencing Web Announcement 3402 with all resubmissions. For future claims in these settings, proactively attach the web announcement reference to bypass denials.