MedicaidReimbursementHigh impact
Attention Provider Type 93 (Substance Use Treatment) Specialties 707 (Substance Use Treatment Clinic) and 708 (Opioid Treatment Program): Rate Update for Procedure Codes H0020 and H0033
Nevada Medicaid·NV · Psychiatry·Reimbursement
Effective date
Mar 1, 2026
We identified it
Sep 1, 2026
Summary
Nevada Medicaid is increasing reimbursement rates for procedure codes H0020 (methadone administration/service) and H0033 (oral medication administration, direct observation) when billed by substance use treatment providers (PT 93, specialties 707 and 708). The rate increase is effective for claims with dates of service on or after March 1, 2026, and previously paid claims will be automatically reprocessed. Billing teams must ensure staff qualifications (physician, PA, APRN, nurse midwife, or RN) are met and be prepared for automatic claim reprocessing.
Action Required
REQUIREMENTS:
- By March 1, 2026: Billing team must verify that all claims for H0020 and H0033 billed by PT 93 (substance use treatment providers) are submitted with appropriate provider qualifications documented (physician, PA, APRN, nurse midwife, or RN). Update billing system to reflect new rate structure for these codes effective March 1, 2026.
- Ongoing (starting March 1, 2026): Monitor remittance advice for automatic reprocessing results of previously paid claims with DOS on or after March 1, 2026. Be aware that reprocessed claims may receive denials due to system and clinical edits; prepare to handle appeals for denied claims per Medicaid Services Manual Chapter 100 and Billing Manual procedures.
- For MCO-contracted providers: Verify MCO implementation of updated rates within 60 days of receiving rate files from the State (MCOs have until 60 days after receiving updates to implement on a go-forward basis).
- Consequence of inaction: Claims may not receive updated reimbursement rates, and providers may miss the opportunity to collect additional payment on automatically reprocessed claims.