MedicaidCoverageHigh impact
Attention Provider Type 22 (Dentist): Service Limitations Updated for Various Procedure Codes
Nevada Medicaid·NV · Dentistry·Provider Enrollment
Effective date
Sep 8, 2025
We identified it
Jun 21, 2026
Summary
Nevada Medicaid has implemented new service limitations for 16 dental procedure codes, effective immediately. Claims exceeding these limitations will be automatically denied, with restrictions ranging from once-in-a-lifetime to specific timeframes like 36 months or 60 months.
Action Required
Immediately: Billing team must update billing software to enforce new service limitations for 16 dental codes. Configure system to track usage history and prevent claims that exceed limitations (ranging from 1 per day to once-in-lifetime per tooth). Update provider encounter forms with limitation warnings. Claims exceeding limits will be automatically denied by Nevada Medicaid MMIS.