Quarter 4 2026 New Code Update

REQUIREMENTS: By September 30, 2026: Billing team must prepare for the October 1, 2026 code update by: - Monitoring Nevada Medicaid's web announcements for the specific list of new Quarter 4 2026 CPT, HCPCS, and ADA codes (announcement to be posted) - Training staff on error code 853 (HCPCS - Annual Update - Suspend Claims) and the claims suspension process - Documenting procedures for submitting retroactive prior authorization requests for new codes requiring prior auth Effective October 1, 2026: Billing team must: - Update billing software to recognize and accept new Quarter 4 2026 codes for dates of service on/after October 1, 2026 - Expect claims with new codes to suspend with error code 853 until Nevada Medicaid releases notification that rates and policies are updated in MMIS - Bypass normal prior authorization timeliness submission requirements for new procedure codes during the transition period - Prepare to submit retroactive prior authorization requests as allowed per interim guidance Ongoing: Billing team must: - Monitor for follow-up announcements from Nevada Medicaid regarding MMIS updates, claim release dates, and prior authorization submission deadlines - Reprocess suspended claims once released, ensuring all system and clinical edits are applied - Appeal any denied claims through the Medicaid appeal process per Chapter 100 and Billing Manual guidelines - Verify that encounter forms and billing templates are updated to use only valid codes per the updated code list (to be provided by Nevada Medicaid) Consequences of inaction: Claims with new codes submitted before October 1, 2026 may be rejected; failure to monitor announcements may result in delayed claim processing and revenue cycle delays; missing the retroactive prior authorization window may result in claim denials.