All Insurance Policy Changes (Page 62)

Continuing from page 61. Showing older policy changes tracked across all payers. Use the filters in the related-hubs section below to narrow by provider, state, or specialty.

Medium impact
Attention All Providers: Urgent/Emergency Enrollment Type Removed for Certain Provider Types
Nevada Medicaid·Effective Feb 18, 2025
Nevada Medicaid has removed urgent/emergency enrollment options for multiple provider types including behavioral health, psychology, ABA, hearing aid dispensers, and various specialty care providers effective February 18, 2025. These providers can no longer use expedited enrollment processes and must follow standard enrollment timelines.
Medium impact
Medicaid Services Manual Chapter 4200 Updated
Nevada Medicaid·Effective Apr 1, 2025
Nevada Medicaid has updated Chapter 4200 of their Services Manual to provide a variety of services to individuals with Fetal Alcohol Spectrum Disorder (FASD) through the Medicaid health home model. This creates new coverage opportunities for FASD-related services starting April 1, 2025.
Medium impact
Attention Provider Types 14 (Behavioral Health Outpatient Treatment) and 82 (Behavioral Health Rehabilitative Treatment): Prior Authorization Requirement Updated for Procedure Code H0038
Nevada Medicaid·Effective Feb 26, 2025
Nevada Medicaid has relaxed prior authorization requirements for peer support services (H0038) for behavioral health providers. Prior authorization is now only required after exceeding 72 units per calendar year, rather than before any services are provided.
Low impact
Indian Health Program Rates Adjusted for Calendar Year 2025
Nevada Medicaid·Effective Jan 1, 2025
Nevada Medicaid has adjusted rates for Indian Health Program providers effective January 1, 2025, for specific preventive medicine and case management codes. Claims processed between January 1-February 24, 2025 may be automatically reprocessed at the new rates.
Medium impact
Attention Provider Types 45 (End Stage Renal Disease (ESRD) Facility) and 81 (Hospital Based ESRD Provider): Rates for Dialysis Codes 90945 and 90999 Adjusted for 2025
Nevada Medicaid·Effective Jan 1, 2025
Nevada Medicaid has adjusted 2025 reimbursement rates for dialysis codes 90945 and 90999 for ESRD facilities and hospital-based ESRD providers, effective January 1, 2025. Claims processed with 2024 rates between January 1 and February 23, 2025 will be automatically reprocessed at the new 2025 rates.
Low impact
Attention All Providers: Provider Flex New Feature – Integrated Checklists
Nevada Medicaid·Identified Jun 21, 2026
Nevada Medicaid is announcing a new feature called 'Integrated Checklists' for their upcoming Provider Flex enrollment tool. This is an informational announcement about upcoming enhancements to streamline the Nevada Medicaid provider enrollment process.
Medium impact
Medicaid Centralized Credentialing Effective February 28, 2025! (Updated March 7, 2025)
Nevada Medicaid·Effective Feb 28, 2025
Nevada Medicaid implemented centralized credentialing effective February 28, 2025, consolidating the credentialing process through a single Credentialing Verification Organization (CVO). This streamlines provider enrollment and primary source verification for all Nevada Medicaid providers.
Medium impact
Drug Use Review (DUR) Board approves changes effective March 3, 2025
Nevada Medicaid·Effective Mar 3, 2025
Nevada Medicaid has added new prior authorization requirements for four respiratory and allergy biologic medications: Fasenra for EGPA treatment, Dupixent for COPD, Tezspire, and Adbry. These changes require prior authorization forms to be submitted through the pharmacy point-of-sale system.
Medium impact
Drug Use Review (DUR) Board approves changes for Physician Administered Drugs (PAD)
Nevada Medicaid·Effective Mar 3, 2025
Nevada Medicaid's Drug Use Review Board updated prior authorization criteria for two physician-administered drugs: Elaprase (idursulfase) had hierarchy corrections, and Zynlonta (loncastuximab tesirine-lpyl) had significant coverage criteria changes including expanded lymphoma indications and updated recertification requirements.
Low impact
Attention All Providers: Provider Flex New Feature – Reaccessing Data
Nevada Medicaid·Identified Jun 21, 2026
Nevada Medicaid is announcing a new provider enrollment tool called Provider Flex with a reaccessing data feature. This is part of an effort to streamline and simplify the Nevada Medicaid enrollment process for providers.
High impact
Attention Provider Types 14 (Behavioral Health Outpatient Treatment), 82 (Behavioral Health Rehabilitative Treatment) and 93 (Substance Use Treatment) Linked to a Provider Type 93 Group: Behavioral Health Services Codes Open For Billing
Nevada Medicaid·Effective Jul 1, 2024
Nevada Medicaid has opened several behavioral health HCPCS codes (H0001, H0015, H0035, H0038, H0047, H2011) for billing by specific provider types effective July 1, 2024. Providers have until April 2, 2025 to submit retroactive prior authorization requests for services already provided, followed by 60 days to submit claims with required documentation.
Medium impact
Attention Provider Types 20 (Physician, M.D., Osteopath, D.O.), 24 (Advanced Practice Registered Nurses), and 77 (Physician’s Assistant): Error Code 5528 Updated for Antepartum Procedure Codes
Nevada Medicaid·Effective Jul 17, 2023
Nevada Medicaid has updated error code 5528 to allow antepartum care procedure codes 59425 and 59426 to be billed by different provider types within the same billing group. Claims for these codes will no longer deny when another provider in the group has already billed for antepartum care within the 9-month rolling period.
Medium impact
Attention Provider Type 85 (Applied Behavior Analysis (ABA)): Reminder of Limitations for Adaptive Behavior Treatment for Individuals
Nevada Medicaid·Identified Jun 21, 2026
Nevada Medicaid is reminding ABA providers of existing hour limits for prior authorization: Focused ABA services are limited to 15-25 hours per week, and Comprehensive ABA services are limited to 25-40 hours per week. Providers can request authorization to exceed these limits with documentation of medical necessity.
Medium impact
Attention Provider 14 (Behavioral Health Outpatient Treatment): Service Limitation Updated for Procedure Code H0002
Nevada Medicaid·Effective Mar 3, 2025
Nevada Medicaid has implemented a service limitation for procedure code H0002 (Behavioral Health Screening) allowing only 1 service per 90 days for Behavioral Health Outpatient Treatment providers (PT 14). Claims exceeding this limit will deny with error code 5544 unless prior authorization is obtained.
Low impact
Attention Provider Types 10 (Outpatient Surgery, Hospital Based) and 46 (Ambulatory Surgical Centers): Rate Update Implemented for Procedure Code G0330
Nevada Medicaid·Effective Jan 1, 2025
Nevada Medicaid has updated the reimbursement rate for procedure code G0330 (dental rehabilitation with monitored anesthesia) for hospital-based outpatient surgery centers and ambulatory surgical centers. Claims with dates of service on or after January 1, 2025 that paid the previous rate will be automatically reprocessed with the new rate.
Low impact
Place of Service Code 27 Added to the Medicaid Management Information System (MMIS)
Nevada Medicaid·Effective Oct 1, 2023
Nevada Medicaid has added Place of Service (POS) code 27 (Outreach Site/Street) to their billing system, allowing providers to bill for services delivered at outreach sites or street locations. This enables proper billing for mobile health services and community outreach programs.
Medium impact
Updates Regarding Durable Medical Equipment (DME) Procedure Codes E0604 and E2512
Nevada Medicaid·Effective Mar 10, 2025
Nevada Medicaid has implemented service limits for hospital-grade electric breast pumps (E0604) effective March 10, 2025, with new error codes for exceeding 1 unit per month or 6 units per 6 months. Additionally, a new rental rate with RR modifier has been added for SGD accessory mounting systems (E2512).
Medium impact
Electronic Records Waiver Application and Guide Now Available
Nevada Medicaid·Effective Mar 13, 2025
Nevada Medicaid now offers electronic health records waiver applications for providers who lack necessary infrastructure or cannot reasonably obtain it. Grant funding applications are available through March 31, 2025 to help providers meet electronic records requirements.
Medium impact
Attention All Providers, Delegates and Staff: Upcoming Training Sessions for Provider Flex, Gainwell Powered Provider Enrollment - Registration Now Open
Nevada Medicaid·Effective Apr 7, 2025
Nevada Medicaid is transitioning to a new provider enrollment system called Provider Flex, with mandatory training sessions starting April 7, 2025. All Nevada Medicaid providers, delegates, and staff must register for and attend overview training sessions to learn the new enrollment tool.
Medium impact
Medicaid Services Manual Chapters Updated
Nevada Medicaid·Effective Mar 1, 2025
Nevada Medicaid updated two manual chapters: Ocular Services (effective Feb 26, 2025) clarifying routine vs medical eye exams, and Home/Community Based Services (effective March 1, 2025) with expanded eligibility criteria and new provider requirements for day and residential habilitation services.
Low impact
New Provider Type 95 (Home and Community Based Services Waiver for Structured Family Caregiving) Available for Enrollment Effective March 17, 2025
Nevada Medicaid·Effective Mar 17, 2025
Nevada Medicaid has created a new Provider Type 95 for Home and Community Based Services Waiver for Structured Family Caregiving, available for enrollment starting March 17, 2025. This provider type serves Nevada Medicaid recipients with dementia or related conditions and provides case management, personal care services, respite care, and health-related services including home health aide services.
Medium impact
Updates Regarding National Correct Coding Initiative (NCCI) Quarter 1 2025 Files
Nevada Medicaid·Effective Jan 1, 2025
Nevada Medicaid implemented replacement files for the National Correct Coding Initiative (NCCI) Quarter 1 2025 update. Claims with dates of service from January 1, 2025 through March 17, 2025 may be automatically reprocessed, which could result in payment adjustments or new denials.
Medium impact
Attention Provider Type 29 (Home Health Agency): Updates to Billing Requirements
Nevada Medicaid·Effective Mar 17, 2025
Nevada Medicaid has eliminated the requirement for Home Health Agency providers (PT 29) to manually enter urban/rural codes (500 or 400) on claims. The system will now automatically assign urban or rural indicators based on the recipient's zip code to ensure proper billing and payment.
Medium impact
Medicaid Management Information System Updated with NCCI Quarter 2 2025 Files
Nevada Medicaid·Effective Apr 1, 2025
Nevada Medicaid has updated its system with CMS NCCI Quarter 2 2025 files, which include new Medically Unlikely Edits (MUE) and Procedure-to-Procedure (PTP) edits that will affect claim processing. These updates will prevent improper payments when incorrect code combinations are reported or service limitations are exceeded.
Medium impact
Attention Provider Type 17 Specialties 180 (Rural Health Clinics) and 181 (Federally Qualified Health Centers): Long-Acting Reversible Contraception (LARC) Devices Services Available
Nevada Medicaid·Effective Jan 1, 2024
Nevada Medicaid now allows Rural Health Clinics and Federally Qualified Health Centers to bill separately for Long-Acting Reversible Contraception (LARC) devices and services under Fee-for-Service instead of bundled PPS rates. These providers can now bill specific CPT and HCPCS codes for IUD and contraceptive implant insertion, removal, and the devices themselves.

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Archive by year

2023 2024 2025 2026

Attention All Providers: Urgent/Emergency Enrollment Type Removed for Certain Provider Types

Medicaid Services Manual Chapter 4200 Updated

Attention Provider Types 14 (Behavioral Health Outpatient Treatment) and 82 (Behavioral Health Rehabilitative Treatment): Prior Authorization Requirement Updated for Procedure Code H0038

Indian Health Program Rates Adjusted for Calendar Year 2025

Attention Provider Types 45 (End Stage Renal Disease (ESRD) Facility) and 81 (Hospital Based ESRD Provider): Rates for Dialysis Codes 90945 and 90999 Adjusted for 2025

Attention All Providers: Provider Flex New Feature – Integrated Checklists

Medicaid Centralized Credentialing Effective February 28, 2025! (Updated March 7, 2025)

Drug Use Review (DUR) Board approves changes effective March 3, 2025

Drug Use Review (DUR) Board approves changes for Physician Administered Drugs (PAD)

Attention All Providers: Provider Flex New Feature – Reaccessing Data

Attention Provider Types 14 (Behavioral Health Outpatient Treatment), 82 (Behavioral Health Rehabilitative Treatment) and 93 (Substance Use Treatment) Linked to a Provider Type 93 Group: Behavioral Health Services Codes Open For Billing

Attention Provider Types 20 (Physician, M.D., Osteopath, D.O.), 24 (Advanced Practice Registered Nurses), and 77 (Physician’s Assistant): Error Code 5528 Updated for Antepartum Procedure Codes

Attention Provider Type 85 (Applied Behavior Analysis (ABA)): Reminder of Limitations for Adaptive Behavior Treatment for Individuals

Attention Provider 14 (Behavioral Health Outpatient Treatment): Service Limitation Updated for Procedure Code H0002

Attention Provider Types 10 (Outpatient Surgery, Hospital Based) and 46 (Ambulatory Surgical Centers): Rate Update Implemented for Procedure Code G0330

Place of Service Code 27 Added to the Medicaid Management Information System (MMIS)

Updates Regarding Durable Medical Equipment (DME) Procedure Codes E0604 and E2512

Electronic Records Waiver Application and Guide Now Available

Attention All Providers, Delegates and Staff: Upcoming Training Sessions for Provider Flex, Gainwell Powered Provider Enrollment - Registration Now Open

Medicaid Services Manual Chapters Updated

New Provider Type 95 (Home and Community Based Services Waiver for Structured Family Caregiving) Available for Enrollment Effective March 17, 2025

Updates Regarding National Correct Coding Initiative (NCCI) Quarter 1 2025 Files

Attention Provider Type 29 (Home Health Agency): Updates to Billing Requirements

Medicaid Management Information System Updated with NCCI Quarter 2 2025 Files

Attention Provider Type 17 Specialties 180 (Rural Health Clinics) and 181 (Federally Qualified Health Centers): Long-Acting Reversible Contraception (LARC) Devices Services Available