← Back to list
Attention Provider Type 63 (Rehabilitative Residential Treatment Services): New Shadow Billing Requirements
Act
by Oct 19, 2026
Effective date
Oct 19, 2026
Identified
Sep 29, 2026
Summary
Effective October 19, 2026, Nevada Medicaid is implementing new shadow billing requirements for Provider Type 63 (Psychiatric Residential Treatment Facilities). Providers must now bill encounter revenue code 0911 with qualified CPT codes as shadow procedure codes in addition to Room & Board codes, though enforcement will not begin until 2027. Only one encounter will be paid per person per day regardless of multiple shadow billed codes submitted.
Get alerts when payers change rules like this one
We check Nevada Medicaid and other payers every day and email you when a change matches your specialty and state.
Get Nevada Medicaid alertsPolicy Monitoring is free. No card required.
What to do
by Oct 19, 2026 · 8 steps
01Billing team must prepare systems for shadow billing implementation.
02Obtain the approved shadow billing CPT codes list from Nevada Medicaid's Billing Information webpage once available.
03Update billing software to support revenue code 0911 with multiple CPT code details on the same claim line for Provider Type 63 specialty 963 claims.
04Configure system to enforce one-encounter-per-person-per-day payment limit.
05Train billing staff on new shadow billing structure and approved codes.
06Update claim submission templates and encounter forms to reflect shadow billing requirements.
07Implementation deadline for enforcement is 2027; a future web announcement will specify the exact mandatory date.
08Claims submitted before enforcement begins will process under current rules and will not be automatically reprocessed.
Original notice
Attention Provider Type 63 (Rehabilitative Residential Treatment Services): New Shadow Billing Requirements
medicaid.nv.gov · Always check the source before changing claims.