MedicaidPrior AuthMedium impact
Attention Provider Type 11 (Inpatient Hospital) and Provider Type 13 (Inpatient Psychiatric Hospital): Administrative Days Policy
Nevada Medicaid·NV · Psychiatry·Provider Enrollment
Effective date
Jun 25, 2024
We identified it
Jun 21, 2026
Summary
Nevada Medicaid has issued updated guidance on administrative days billing for inpatient hospitals and psychiatric facilities. Administrative days are lower-reimbursed hospital days for patients who no longer need acute care but cannot be discharged due to lack of appropriate placement, requiring prior authorization and specific revenue codes.
Action Required
Immediately: Billing teams at inpatient hospitals (Provider Type 11) and psychiatric hospitals (Provider Type 13) must ensure use of revenue codes 0160 and 0169 for administrative days billing. Obtain prior authorization from QIO-like vendor before billing administrative days. Maintain comprehensive discharge planning documentation including placement efforts, contacts, discharge planning notes, physician orders, and modification records. Administrative days can only be billed after at least one acute inpatient day.