← Back to list
Attention Provider Type 63 (Psychiatric Residential Treatment Facilities): Guidance for Requesting Complex Case Criteria
Act
by Aug 1, 2026, the billing team must
Effective date
Aug 1, 2026
Identified
Sep 9, 2026
Summary
Nevada Medicaid has activated a new revenue code 0120 (effective August 1, 2026) for complex case rates at Psychiatric Residential Treatment Facilities (PRTF) for children under 10 or those meeting complex criteria. Providers must use the FA-15 Prior Authorization form to request this rate and cannot bill revenue codes 0100 (flat rate) and 0120 simultaneously. If the wrong revenue code was initially submitted, providers have 5 business days to correct it using form FA-29 with supporting documentation.
Get alerts when payers change rules like this one
We check Nevada Medicaid and other payers every day and email you when a change matches your specialty and state.
Get Nevada Medicaid alertsPolicy Monitoring is free. No card required.
What to do
by Aug 1, 2026, the billing team must · 7 steps
01Update billing software to recognize and allow revenue codes 0100 and 0120 for PRTF claims, with validation rules preventing simultaneous submission of both codes on the same claim.
02Train billing staff on the FA-15 Prior Authorization form requirements, specifically the Complex Case Criteria section and mandatory checkbox selections based on member age.
03Establish a monitoring process to identify claims initially submitted with revenue code 0100 that should have used 0120, and submit FA-29 data correction forms within 5 business days of PA approval with supporting clinical documentation.
04For members under 10 years old, configure the system to accept initial requests up to the member's 10th birthday in 90-day increments.
05For members 10 and older, require providers to document medical necessity and request concurrent review when checking complex criteria boxes on FA-15 forms.
06Failure to comply will result in claim denials and delays in reimbursement.
07Contact ResidentialTreatment@nvha.nv.gov with questions.
Original notice
Attention Provider Type 63 (Psychiatric Residential Treatment Facilities): Guidance for Requesting Complex Case Criteria
medicaid.nv.gov · Always check the source before changing claims.