Overview
The Rate Analysis and Development (RAD) team is responsible for Letters of Agreement (LOA); rate appeals, policies, reviews, studies, and scheduled updates; and the Quadrennial Rate Reviews as required by Assembly Bill 108 (AB 108) passed in the 2017 Nevada Legislative Session and the Quadrennial Rate Reviews as required by NRS 422.2704. The RAD team is also responsible for fiscal impact analyses associated with the above processes as well as legislative, policy, and regulatory changes to the Nevada Medicaid program.
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.
Annual Code Update
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.
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.
Fee Schedules
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.
Please note that the fee schedules linked below will not reflect the rate increases approved during the 2023 Legislative Session. All rate increases must be implemented via State Plan and Waiver Amendments that must be approved by CMS prior to implementing the rate changes. Please see the State Plan Amendment Section below; additional information will be posted as it becomes available.
Physician Administered Drug (PAD) Pricing Reimbursement Schedules
Managed Care
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.
*All Schedules listed below are noted to be in a pending state and are subject to change.
IID Waiver Rate Study
The Cost Study for the Waiver for Individuals with Intellectual Disabilities and Related Conditions. In July 2020, a cost study for the Waiver for Individuals with Intellectual Disabilities (IDD) and Related Conditions was undertaken by Burns & Associates, a Division of Health Management Associates. During March and April, providers were surveyed about costs related to the services they provide and cost related to their employees and the benefits that are offered to their employees. 88 providers were sent surveys. 16 returned responses. This accounted for 18.2% of the provider community and 47% of all claims by payment for IDD Waiver services. The proposed rates and the rates presentation are below. Please note that rate changes would need to be approved by the legislature and that a completed rate study does not guarantee a rate increase.
Nursing Facilities
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, please contact Rates@dhcfp.nv.gov.
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. Additional information related to rate changes that were approved during the 2023 Legislative Session will be posted as it becomes available.