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Nevada MedicaidMedicaid · Billing Codes · Provider Announcement · NVHigh impact

Quarter 4 2026 New Code Update

Act
by Sep 30, 2026
Effective date
Oct 1, 2026
Identified
Sep 23, 2026

Summary

Nevada Medicaid has added new CPT, HCPCS, and ADA codes effective October 1, 2026. All claims using Quarter 4 2026 codes will initially suspend with error code 853 until rates and policy details are updated in the MMIS system. Providers can submit retroactive prior authorization requests during this interim period without standard timeliness penalties.

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What to do

by Sep 30, 2026 · 5 steps
01Billing team must prepare to implement new Quarter 4 2026 codes in the billing system for dates of service on or after October 1, 2026.
02Expect initial claim suspensions with error code 853 and monitor for additional Nevada Medicaid web announcements regarding rate updates and policy details.
03When suspended claims are released for adjudication, reprocess all claims and be prepared for potential denials or reduced payments due to system and clinical edits.
04Prior authorization requests for new codes requiring PA can be submitted retroactively without standard timeliness requirements; establish a process to track and submit retroactive PA requests for applicable codes.
05Communicate with clinical staff that they must document medical necessity for new procedures, as reprocessed claims will be subject to all standard edits and may result in additional denials.

Original notice

Quarter 4 2026 New Code Update
medicaid.nv.gov · Always check the source before changing claims.
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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

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