Summary
Nevada Medicaid is implementing new CPT, HCPCS, and ADA codes for Quarter 4 2026, effective October 1, 2026. New codes will initially suspend with error code 853 until rates and policies are loaded into the system. Providers can submit retroactive prior authorization requests during this transition period, with timeliness requirements waived for new codes requiring prior auth.
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What to do
Action · 1 steps
01REQUIREMENTS:
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.
Original notice
Quarter 4 2026 New Code Update
medicaid.nv.gov · Always check the source before changing claims.
Related changes
See all Nevada Medicaid changes →Quarter 4 2026 New Code UpdateMediumEffective Oct 27, 2026 · Provider AnnouncementQuarter 4 2026 New Code UpdateHighEffective Oct 1, 2026 · Provider AnnouncementQuarter 3 2026 New Code UpdateMediumEffective Jul 1, 2026 · Provider Announcement2024 Annual New Code UpdateMediumEffective May 28, 2024 · Provider AnnouncementBrowse every Nevada Medicaid change in the policy list