MedicaidPrior AuthHigh impact
Attention Provider Types 12 (Hospital, Outpatient) and 96 (Rural Emergency Hospital): Prior Authorization Requirements Updated for Therapy Services for Children Three Years Old and Younger
Nevada Medicaid·NV · Physical Therapy, Occupational Therapy, Speech Therapy +1 more·Prior Authorization
Effective date
May 27, 2026
We identified it
Jul 14, 2026
Summary
Nevada Medicaid eliminates prior authorization requirements for physical, occupational, and speech therapy services provided to children three years old and younger by hospital outpatient (PT 12) and rural emergency hospital (PT 96) providers, effective May 27, 2026. Previously denied claims without prior authorization will be automatically reprocessed for correct adjudication.
Action Required
By May 27, 2026: Billing team must update Nevada Medicaid billing system to remove prior authorization requirements for therapy services (physical therapy, occupational therapy, speech therapy) for patients age 3 and younger when billing under provider types 12 (Hospital, Outpatient) and 96 (Rural Emergency Hospital). Update internal billing policies and staff training to reflect that PA is no longer required for these services. Monitor for automatic reprocessing of previously denied claims and be prepared to address any denials upon reprocessing, including appeals if necessary. Ensure front-end staff and providers understand the change to prevent submission delays.