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Further Clarification of Certain Billing Procedures for Substance Use Treatment Services
Effective date
Sep 11, 2026
Identified
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.
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What to do
Action · 4 steps
01Effective 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.
02Update billing software validation rules and claims scrubbing logic.
03Educate all billing staff and providers billing SUD services on this restriction.
04Implement manual review process for admission/discharge date exceptions.
If missed: Failure to comply will result in claim denials for duplicative services and potential overpayment recovery.
Codes mentioned
H0018H0019H0011H0001H0005H0007H0015H0020H0033H0035H0047H0049803058030680307
Original notice
Further Clarification of Certain Billing Procedures for Substance Use Treatment Services
medicaid.nv.gov · Always check the source before changing claims.
Related changes
See all Nevada Medicaid changes →Attention Provider Types 14 (Behavioral Health Outpatient Treatment), 82 (Behavioral Health Rehabilitative Treatment), and 93 (Substance Use Treatment): Substance Use Treatment and Behavioral Health Procedure Codes Available for Billing (Updated)HighEffective Jul 1, 2024 · Billing & CodingAttention Provider Types 14 (Behavioral Health Outpatient Treatment), 82 (Behavioral Health Rehabilitative Treatment) and 93 (Substance Use Treatment) Linked to a Provider Type 93 Group: Behavioral Health Services Codes Open For BillingHighEffective Jul 1, 2024 · Billing & CodingAttention Provider Type 93 (Substance Use Treatment): New Residential Substance Use Disorder (SUD) Bundled Rates for Level 3 Providers (Updated January 23, 2025)MediumNo effective date · Provider EnrollmentAttention Provider Type 93 (Substance Use Treatment): Substance Use Treatment Procedure Codes H0011, H0018, and H0019 Open for BillingMediumEffective Jul 31, 2024 · Billing & CodingBrowse every Nevada Medicaid change in the policy list