MedicaidPrior AuthHigh impact
Attention Provider Type 63 (Psychiatric Residential Treatment Facilities): Guidance for Requesting Complex Case Criteria
Nevada Medicaid·NV · Psychiatry, Pediatrics·Provider Enrollment
Effective date
Aug 1, 2026
We identified it
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.
Action Required
By August 1, 2026, the billing team must: (1) Update 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; (2) Train billing staff on the FA-15 Prior Authorization form requirements, specifically the Complex Case Criteria section and mandatory checkbox selections based on member age; (3) Establish 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; (4) For members under 10 years old, configure the system to accept initial requests up to the member's 10th birthday in 90-day increments; (5) For members 10 and older, require providers to document medical necessity and request concurrent review when checking complex criteria boxes on FA-15 forms. Failure to comply will result in claim denials and delays in reimbursement. Contact ResidentialTreatment@nvha.nv.gov with questions.