MedicaidReimbursementHigh impact
Attention Provider Type 63 (Psychiatric Residential Treatment Facility (PRTF)): Rate Reform Implemented for Private PRTFs
Nevada Medicaid·NV · Psychiatry, Pediatrics·Reimbursement
Effective date
Jan 1, 2025
We identified it
Jul 23, 2026
Summary
Nevada Medicaid implemented rate reform for private Psychiatric Residential Treatment Facilities (PRTF, Provider Type 63) effective January 1, 2025. Private PRTFs now receive a flat rate of $800 for revenue codes 100 and 183, with an optional $150 add-on (maximum $950) for children under 10 or those with complex needs. Prior authorization using new revenue code 120 and form FA-15 is required for the add-on rate, effective August 1, 2026. Retroactive claim reprocessing has begun for eligible claims.
Action Required
By August 1, 2026: Billing team must implement the following changes for all PRTF claims (Provider Type 63): (1) Update billing system to apply flat rate of $800 to revenue codes 100 and 183; (2) Configure system to require prior authorization using new revenue code 120 for the $150 add-on (maximum total $950) for patients under age 10 or with complex needs; (3) Update encounter forms and templates to prompt providers to identify qualifying patients; (4) Obtain and integrate the updated form FA-15 (Psychiatric Residential Treatment Facility Prior Authorization) from Nevada Medicaid website; (5) Train billing staff on the complex case definition criteria when FA-15 is updated. Immediately: Verify all claims with dates of service January 1, 2025 or later have been automatically reprocessed and monitor remittance advice for results. Failure to obtain prior authorization for the add-on rate will result in claim denials at the $800 flat rate only. Note: Claims are being automatically reprocessed retroactively; monitor for additional payments and potential denials from clinical edits.