MedicaidCoverageHigh impact
Further Clarification of Certain Billing Procedures for Substance Use Treatment Services
Nevada Medicaid·NV · Psychiatry, General Practice·Billing & Coding
Effective date
Sep 11, 2026
We identified it
Sep 12, 2026
Summary
Nevada Medicaid clarifies that members receiving residential substance use treatment at ASAM levels 3.1, 3.5, or 3.7 (PT 93 providers) cannot simultaneously bill outpatient SUD services on the same date of service, except on admission and discharge dates. A specific list of outpatient codes is prohibited from being billed concurrently with residential SUD codes to eliminate duplicative billing.
Action Required
Effective immediately: Billing team must implement system-level edits to prevent billing any outpatient SUD codes (H0001, H0005, H0007, H0015, H0020, H0033, H0035, H0047, H0049, 80305, 80306, 80307) on the same date of service as residential SUD codes (H0018, H0019, H0011) for Nevada Medicaid claims, with the exception of admission and discharge dates. Update billing software validation rules and claims scrubbing logic. Educate all billing staff and providers billing SUD services on this restriction. Implement manual review process for admission/discharge date exceptions. Failure to comply will result in claim denials for duplicative services and potential overpayment recovery.