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Attention Provider Type 63 (Psychiatric Residential Treatment Facilities): Guidance for Requesting Complex Case Criteria (Updated October 1, 2026)
Act
by Aug 1, 2026
Effective date
Aug 1, 2026
Identified
Oct 2, 2026
Summary
Nevada Medicaid has introduced a new revenue code 0120 for complex case rates at psychiatric residential treatment facilities (PRTF) for children under 9 or those meeting complex case criteria, effective August 1, 2026. Providers must use Form FA-15 to request this rate and cannot submit revenue codes 0100 and 0120 simultaneously. If the wrong code was initially submitted, providers must file a data correction (Form FA-29) within 5 business days.
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What to do
by Aug 1, 2026 · 5 steps
01Billing team must update systems to recognize revenue code 0120 for complex case rates at PRTF providers and enforce mutual exclusivity rules preventing simultaneous submission of codes 0100 and 0120.
02Update billing software and prior authorization workflows to require Form FA-15 completion with Complex Case Criteria section checked (either age under 9 or applicable complex case criteria boxes).
03Providers must include supporting clinical documentation demonstrating need for one-to-one staff support.
04Establish process for submitting Form FA-29 corrections within 5 business days if code 0100 was initially submitted in error.
05Training required for billing and clinical staff on proper code selection and documentation requirements.
Original notice
Attention Provider Type 63 (Psychiatric Residential Treatment Facilities): Guidance for Requesting Complex Case Criteria (Updated October 1, 2026)
medicaid.nv.gov · Always check the source before changing claims.