MedicaidBilling CodesHigh impact
Attention Provider Type (PT) 17 Specialty 181 (Federally Qualified Health Centers (FQHC)): Implementation of Dental Shadow Billing, January 1, 2027
Nevada Medicaid·NV · Dentistry·Billing & Coding
Effective date
Jan 1, 2027
We identified it
Jul 2, 2026
Summary
Nevada Medicaid is implementing Dental Shadow Billing for FQHCs effective January 1, 2027. FQHCs providing dental services must transition from CPT 41899 (CMS 1500 form) to ADA code D2999 (ADA form/837D transactions), discontinue DBA Supplemental Payment billing after December 31, 2026, and configure systems to use Primary and Supplementary Shadow Billing Codes for dental encounter reporting.
Action Required
By December 31, 2026: (1) Billing team must verify that trading partners/clearinghouses are certified to submit 837D transactions (dental claim form); contact EDI Trading Partner Registration if certification is incomplete. (2) Update billing software configuration to replace CPT 41899 with ADA code D2999 for all dental encounters at FQHCs. (3) Stop billing DBA Supplemental Payment Program codes for dates of service on or after January 1, 2027. (4) Once Nevada Medicaid releases the finalized Shadow Billing Code list (expected in months prior to implementation), import Primary Shadow Billed codes (at least one required per encounter on secondary claim line) and Supplementary Shadow Billed codes (for additional service detail on separate claim lines) into the billing system. (5) Configure system to bill dental encounters on ADA form (837D) rather than CMS 1500. (6) Providers/billing staff should monitor Nevada Medicaid website and Nevada Primary Care Association for the Shadow Billing Code list distribution. Failure to transition by January 1, 2027 will result in claim denials for dental services billed under the old coding structure. Note: WRAP payments will continue for appropriately billed claims with dates of service prior to January 1, 2027 for up to 180 days (in-state) or 365 days (out-of-state) after implementation.