Nevada Medicaid and Nevada Check Up News (Fourth Quarter 2025 Provider Newsletter) [Read]

Attention Behavioral Health Providers: Monthly Behavioral Health Training Assistance (BHTA) Webinar Scheduled [See Web Announcement 2009]

Attention All Providers: Requirements on When to Use the National Provider Identifier (NPI) of an Ordering, Prescribing or Referring (OPR) Provider on Claims [Announcement 850]

If you are a Medicaid provider whose revalidation application has not been processed by your termination due date, you will be ineligible to provide services to any Nevada Medicaid or Nevada Check Up recipients, including both Fee-for-Service and Managed Care Organization (MCO) enrolled recipients. See Web Announcement 1265

Enrollment Termination Frequently Asked Questions (FAQs) [Review]

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EDI Trading Partners: If you have not already scheduled a migration date for your SFTP connection to the new URL, please contact NV MMIS EDI Support immediately. SFTP services at sftp.medicaid.nv.gov will be discontinued starting January 21, 2026.
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Top 10 Claim Denial Reasons and Resolutions/Workarounds for December 2025 Professional Claims. See Web Announcement 3789.

Top Prior Authorization Denial Reasons for the Fourth Quarter of 2025. See Web Announcement 3830.

Attention Providers Using the Authorization Criteria Function: Results that return prior authorization (PA) requirements are accurate. For results that return “There are no records found based on the search criteria,” there may be a PA requirement if limits have been exceeded. To verify PA requirements, please refer to the Medicaid Services Manual (MSM) Chapter for your service type at dhcfp.nv.gov and the Billing Guide for your provider type at www.medicaid.nv.gov.

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1. NV_BillingGuidelines_PT34.pdf
... Required 97605 Negative pressure wound therapy Required 97606 Total wound surface area greater than 50 square Required centimeters 97760 Orthotic(s ) fitting and training, upper extremity( ...
Terms matched: 1  -  Score: 26  -  31 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT34.pdf
2. NV_BillingGuidelines_PT34_2023-1121.pdf
... Required 97605 Negative pressure wound therapy Required 97606 Total wound surface area greater than 50 square Required centimeters 97760 Orthotic(s ) fitting and training, upper extremity( ...
Terms matched: 1  -  Score: 26  -  31 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT34_2023-1121.pdf
3. FA-1B.pdf
... place of residency Hospital Nursing Facility ICF / MR Group Home Assisted Living Private Home Apartment Temporary Lodging Other (specify): ____ Length of Residency: ____ ...
Terms matched: 1  -  Score: 16  -  09 May 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FA-1B.pdf
4. web_announcement_3560_20250220.pdf
... provider website For more information about PT 93, see the following web announcements (WA): • WA 3383 • WA 3452 †...
Terms matched: 1  -  Score: 124  -  20 Feb 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3560_20250220.pdf
5. web_announcement_3545_20250131.pdf
... €¢ Q4133 (Grafix prime, grafixpl prime, stravix and stravixpl, per square centimeter) • Q4186 (Epifix, per square centimeter) â ...
Terms matched: 1  -  Score: 53  -  31 Jan 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3545_20250131.pdf
6. web_announcement_3543_20250129.pdf
... Code Description Q4133 (Grafix prime, grafixpl prime, stravix and stravixpl, per square centimeter) Q4186 (Epifix, per square centimeter) Q4101 (Apligraf, ...
Terms matched: 1  -  Score: 58  -  29 Jan 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3543_20250129.pdf
7. web_announcement_3501_20241211.pdf
... procedure codes Q4133 (Grafix prime, grafixpl prime, stravix and stravixpl, per square centimeter), Q4186 (Epifix, per square centimeter), and Q4101 ...
Terms matched: 1  -  Score: 62  -  17 Dec 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3501_20241211.pdf
8. Inhaled Antimuscarinics.pdf
... nebulization: maintenance, 500 Î ¼ g QID, dose six to eight hours apart Tiotropium Maintenance treatment of bronchospasm Safety and Powder for oral associated with chronic obstructive ...
Terms matched: 1  -  Score: 11  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Inhaled%20Antimuscarinics.pdf
9. Inhaled Anticholinergics_09222016.pdf
... 12 h compared to placebo. o In GEM1, the change from baseline least squares (LS) mean was 0.125 L in the glycopyrrolate group compared to -0.014 ...
Terms matched: 1  -  Score: 13  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Inhaled%20Anticholinergics_09222016.pdf
10. Inhaled Antimuscarinics 2012 12.pdf
... , 500 nebulization ® Î ¼ g QID, dose six to eight hours apart (Atrovent ): 500 Î ¼ g (0.02%) Tiotropium Maintenance ...
Terms matched: 1  -  Score: 11  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Inhaled%20Antimuscarinics%202012%2012.pdf
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