The Rate Analysis
& Development Unit is responsible for: rate development; rate study/review; rate appeals; annual and quarterly updates; and nursing facility rates.
Nevada Medicaid administers the program with provisions of the Nevada Medicaid State Plan, Titles XI and XIX for the Social Security Act, all applicable Federal regulations and other official issuance of the Department. Methods and standards used to determine rates for inpatient and outpatient services are located in the State Plan under Attachments 4.19 A through E.
New Codes for 2019
Fee Schedule Search
Nevada Medicaid has a new feature on the Nevada Medicaid Provider Portal website under the Provider “Home” page (EVS). The new feature will allow Providers to not only view fee schedules, but also the ability to verify member eligibility, search for claims, payment information and Remittance Advices. For modifier or anesthesia base units, see the appropriate links below. Please refer to the appropriate Medicaid policy to fully determine coverage as well as any coverage limitations. Medicaid policy takes precedence over any code and rate listed here for a particular provider type.
The fee schedules found here are updated on an annual basis, sometimes more frequently. Information regarding the annual new code update may be found on this website.
The information contained in these schedules is made available to provide information and is not a guarantee by the State or the Department or its employees as to the present accuracy of the information contained herein.
Quadrennial Rate Reviews
State Plan Amendments (SPA) - Rates
When Nevada Medicaid is planning to make a change to its rate methodologies, program policies or operational approach, a State Plan Amendment (SPA) with the proposed changes is sent to the Centers for Medicare and Medicaid Services (CMS) for review and approval. Workshops and public hearings are held prior to submitting a SPA to CMS allowing providers and stakeholders the opportunity to provide public comment.
The links below are current SPAs not related to the rate increases approved during the 2019 Legislative Session:
State Plan Amendments (SPA) - 2019 Legislative Session
The Legislatively approved budget from the 2019 Session
includes increased rates for various services.
These rate increases require SPAs to be submitted to CMS for their
review and approval. The links to the
proposed changes are provided below.
Please note, these changes cannot be considered final until approval is
received from CMS:
Rates are acuity-adjusted on a quarterly basis. Reimbursement methodology may be found in the State Plan, Attachment 4.19-D.
If you need information regarding Nursing Facility rates other than what is provided below, you may contact our office and our staff may assist you; 775-684-7972.
Annual Physician Rate Reports (NRS 422.2712)
The Department of Health and Human Services provides the following reports detailing the Medicaid and Children’s Health Insurance Program (CHIP) rate of reimbursement for physicians which is provided on a Fee for Service basis and which is lower than the rate provided on the current Medicare fee schedule for care and services provided by physicians.
Supplemental Payment Programs