← Back to list
Attention Provider Type 63 (Rehabilitative Residential Treatment Services): New Shadow Billing Requirements
Effective date
Oct 19, 2026
Identified
Oct 20, 2026
Summary
Nevada Medicaid has implemented new shadow billing requirements for Provider Type 63 (Psychiatric Residential Treatment Facilities) effective October 19, 2026. Providers must use encounter revenue code 0911 with qualified CPT codes as shadow procedure codes alongside Room & Board codes, though enforcement is deferred until 2027. A supplemental document listing approved shadow billing codes will be posted to the Billing Information webpage.
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
Action · 6 steps
01Billing team should.
02Monitor for the future Nevada Medicaid web announcement regarding the mandatory enforcement date for shadow billing (expected in 2027).
03Obtain the supplemental document with approved CPT codes for shadow billing from the Nevada Medicaid Billing Information webpage.
04Update the billing system to require encounter revenue code 0911 with at least one qualified CPT code on claims for PT 63 specialty 963 providers.
05Train staff that multiple detail lines with different shadow billed codes may be submitted under revenue code 0911, but only one encounter will be paid per person per day.
06Coordinate with PT 63 specialty 963 providers to ensure they understand the go-forward policy (no retroactive claim reprocessing) and implement changes in their claim submission process before the 2027 mandatory enforcement date.
Original notice
Attention Provider Type 63 (Rehabilitative Residential Treatment Services): New Shadow Billing Requirements
medicaid.nv.gov · Always check the source before changing claims.