MedicaidReimbursementHigh impact
Attention Provider Type 33 (Durable Medical Equipment, Disposable, Prosthetics): Billing Guide Updated
Nevada Medicaid·NV · Physical Therapy, Occupational Therapy, Wound Care +1 more·Billing & Coding
Effective date
Jul 30, 2026
We identified it
Jul 31, 2026
Summary
Nevada Medicaid updated the reimbursement methodology for DMEPOS equipment (Provider Type 33) with $0 or unassigned rates, effective July 30, 2026. Providers must now submit invoices or quotes with prior authorization or claims, and reimbursement will be calculated as the lowest of: (a) MSRP less 25%, (b) acquisition cost plus 20%, or (c) actual charge submitted. Providers are responsible for verifying and submitting documentation supporting the calculation.
Action Required
By July 30, 2026: Billing team must implement the following changes for all DMEPOS claims (Provider Type 33) with $0 or unassigned rates: (1) Update billing system to require submission of manufacturer invoices or quotes documenting MSRP with all prior authorizations and claims; (2) Configure claims processing to calculate reimbursement using the three-tier methodology (MSRP less 25%, acquisition cost plus 20%, or actual charge) and pay the lowest amount; (3) Create a checklist for billing staff to verify that both MSRP and acquisition cost documentation are attached before claim submission; (4) Train all billing and authorization staff on the new requirements; (5) Update claim templates and prior authorization forms to explicitly require MSRP and cost documentation fields. Failure to provide supporting documentation will result in claim denials or recoupment per Nevada state plan section 4.19-B.7.d.3. Review the updated billing guide on the Nevada Medicaid Billing Information page.