Attention Provider Type 17 (Special Clinics) Specialty 181 (Federally Qualified Health Center): Shadow Billing Updates

By December 31, 2025: Billing team must update Nevada Medicaid billing system configuration to implement all shadow billing code changes. ADDITIONS/UPDATES: (1) Enable CPT 99205, 99242-99245, and H0049 for both medical and behavioral health encounter billing; (2) Add CPT 99401 with Modifier FP to the system with a 2-unit annual limit per recipient and enable for both medical and behavioral health encounters; (3) Configure system to apply service limit edits at claim submission. DELETIONS: (1) End-date and remove CPT 59514, 59612, 59620, 59812, 99401 with Modifier CR, and G2214 from billable codes; (2) Configure system to reject these codes as invalid for shadow billing as of January 1, 2026. RESTRICTIONS: (1) Limit CPT 98960, 98961, and 98962 to medical encounters only; remove from behavioral health encounter billing rules. Billing team must verify changes are live in MMIS before January 1, 2026. Download and review the updated FQHC Shadow Billing CPT Codes List from the Nevada Medicaid FQHC website to confirm all code updates. Providers and clinical staff should be notified of modifier requirements (FP vs. CR) and annual limits. Claims submitted with end-dated codes after January 1, 2026 will be denied; retroactive claims will be automatically reprocessed and may receive denials or no additional payment.