Nevada Billing Guide for Mental Health Therapists and Psychiatrists
Who pays, where to enroll and which rules change your claims in Nevada, for psychotherapists and psychiatric prescribers.
Last checked October 25, 2026. Reviewed against the official sources listed at the bottom of this page.
This Nevada billing guide covers Medicaid, Medicare, Blue Cross, other private payers and state law for therapists and psychiatrists, with sources and a last-checked date.
Nevada billing guide: how Nevada pays for outpatient care
Nevada Medicaid and Nevada Check Up are operated by the Nevada Health Authority (NVHA); the Division of Health Care Financing and Policy (DHCFP) name still appears on dhcfp.nv.gov pages. Since January 1, 2026, Medicaid managed care covers the whole state, including rural counties for the first time, with five plans (Anthem Blue Cross and Blue Shield Healthcare Solutions, CareSource, Health Plan of Nevada, Molina and SilverSummit); fee-for-service claims go to the Gainwell Technologies-run portal.
Fee-for-service claims from in-state providers must be received within 180 days of the later of the date of service or the eligibility decision (365 days with third-party liability or for out-of-state providers), and the plans we opened list 180 days. The Blue licensee is Anthem Blue Cross and Blue Shield, the trade name of Rocky Mountain Hospital and Medical Service, Inc. in Nevada, and Medicare Part B is handled by Noridian in Jurisdiction E. Plan pages from SilverSummit say Nevada Medicaid work requirements start January 1, 2027 for some expansion adults aged 19 to 64.
Who to bill, at a glance
| Payer type | Who you bill | Where to enroll or check rules |
|---|---|---|
| Medicaid | Nevada Medicaid and Nevada Check Up (managed care statewide since 1/1/2026, plus fee-for-service for exempt or excluded members): Nevada Health Authority (NVHA), which operates Nevada Medicaid; the Division of Health Care Financing and Policy (DHCFP) name still appears on dhcfp.nv.gov. | Provider enrollment |
| Medicare Part B | Noridian Healthcare Solutions, LLC | CMS MAC page |
| Blue Cross Blue Shield | Anthem Blue Cross and Blue Shield (Rocky Mountain Hospital and Medical Service, Inc.) | See the Blue Cross section below |
Nevada Medicaid and how to bill it
This Nevada billing guide starts with Medicaid, because it decides who pays and how you file.
Per Web Announcement 3753 (10/24/2025), Nevada moved to statewide Medicaid managed care on January 1, 2026. Clark County plans: Anthem, CareSource, Health Plan of Nevada, Molina and SilverSummit. Washoe County plans: Anthem, CareSource, Molina and SilverSummit. Rural counties: CareSource and SilverSummit.
Behavioral health: No statewide behavioral health carve-out was found. Web Announcement 3753 says all five plans cover behavioral health. Anthem's Nevada Medicaid plan uses Carelon Behavioral Health (quick reference guide dated 2.7.2023).
| Item | What to know |
|---|---|
| Agency | Nevada Health Authority (NVHA), which operates Nevada Medicaid; the Division of Health Care Financing and Policy (DHCFP) name still appears on dhcfp.nv.gov |
| Claims or fiscal agent | Gainwell Technologies (named as fiscal agent in the Nevada Medicaid Billing Manual; Provider Web Portal 'Powered by Gainwell'); Gainwell Technologies Contact Center (877) 638-3472 |
| Provider enrollment | Official enrollment page |
| Manual or fee schedule | Official manual or fee schedule |
| Provider portal | Provider portal |
| Work requirement | SilverSummit's member page and its provider HR1 toolkit (8/17/2026) say that starting January 1, 2027 some Nevada Medicaid expansion adults aged 19 to 64 must show 80 hours a month of work, school, training or community service, or earn at least $580 a month, unless exempt. |
Managed-care plans and carve-outs
| Plan or entity | Role in behavioral health |
|---|---|
| Anthem Blue Cross and Blue Shield Healthcare Solutions | Clark and Washoe. Provider Services (844) 396-2330 per DHCFP contact page. |
| CareSource | Clark, Washoe and rural Nevada (rural awardee). |
| Health Plan of Nevada Medicaid (UnitedHealthcare) | Clark County only from 1/1/2026 per HPN notice updated 8/20/2025. |
| Molina Healthcare of Nevada | Clark and Washoe. Phone (833) 685-2103 listed on Molina's Nevada Medicaid contact page. |
| SilverSummit Healthplan | Clark, Washoe and rural Nevada (rural awardee). |
The count runs from the last date of service. The limit may be waived if you document delays caused by errors on the part of NVHA, Nevada Medicaid or Gainwell, by filing, getting a timely filing denial, then appealing.
Medicare Part B in Nevada
For Medicare, this Nevada billing guide names your contractor and the current telehealth rules.
As of 2026-10-25, per the CMS Telehealth FAQ (updated 10/8/26): beneficiaries can receive Medicare telehealth services through December 31, 2027, including audio-only telehealth in the home. Starting January 1, 2028, beneficiaries will generally need to be in a medical facility in a rural area, except for behavioral health services.
| Item | What to know |
|---|---|
| Contractor | Noridian Healthcare Solutions, LLC |
| Jurisdiction | Jurisdiction E (JE): American Samoa, California, Guam, Hawaii, Nevada and Northern Mariana Islands. |
| Source | CMS.gov MAC page |
Blue Cross Blue Shield in Nevada
This part of the Nevada billing guide names the exact Blue Cross licensee, because Blue plans never share rules.
Blue Cross Blue Shield is a federation of independent companies, so one licensee's rules never apply to another. Here is who holds the Blue license in Nevada.
| Licensee | Parent or affiliation | Where it applies | Provider resources |
|---|---|---|---|
| Anthem Blue Cross and Blue Shield (Rocky Mountain Hospital and Medical Service, Inc.) | Blue Cross Blue Shield Association licensee | Anthem's legal notice lists 'In Nevada: Rocky Mountain Hospital and Medical Service, Inc.' as the entity behind the Anthem Blue Cross and Blue Shield trade name, with HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. | Source |
Other private payers and EAPs in Nevada
The Nevada billing guide also covers commercial plans and employee assistance programs.
These commercial payers and plan families most often matter for behavioral health billing in Nevada. Check each payer's current provider manual before you submit.
| Payer | Behavioral health note | Provider resources |
|---|---|---|
| Aetna (Aetna Health Inc. files MHPAEA reports with the Nevada Division of Insurance) | Aetna's health care professional contact page lists 1-888-MD Aetna (632-3862) for indemnity and PPO-based plans. | Official page |
| Cigna / Evernorth Behavioral Health | National Cigna provider contact page lists Evernorth Behavioral Health 800.926.2273 and 800.88Cigna (882.4462). Not Nevada-specific. | Official page |
| UnitedHealthcare / Optum Behavioral Health | UnitedHealthcare lists behavioral health at 877-614-0484 and General provider assistance at 877-842-3210; its Nevada entries are All Savers 800-291-2634 and Medicare Advantage and Community Plan 888-866-8297. | Official page |
| Ambetter from SilverSummit Healthplan | Ambetter Nevada quick reference guide lists Provider Services 1-866-263-8134 and timely filing of 180 days, payer ID 68069. | Official page |
Nevada billing guide: state law that changes billing
Use this section of the Nevada billing guide to separate state law from payer policy.
State law sets the floor for commercial plans in Nevada. Medicare and Medicaid rules are covered in their own sections above.
Mental health parity
NRS 687B.404 requires insurers and other covered organizations to comply with the federal Mental Health Parity and Addiction Equity Act (MHPAEA), and requires the Commissioner of Insurance to send a data request each year by July 1 to evaluate compliance and to report by December 31 to the Patient Protection Commission, the Governor and the Legislative Counsel Bureau. Citation: NRS 687B.404; AB 181 (2021); 42 U.S.C. 300gg-26(a)(8); 45 CFR 146.136. Source
Telehealth coverage and payment parity
Senate Bill 119 (2023), effective July 1, 2023, requires insurers, health plans and the Medicaid State Plan to cover telehealth as though provided in person or by other means, and requires reimbursement to match in-person payment for counseling or treatment for a mental health condition or substance use disorder, including when delivered by audio-only interaction. Source
Prompt payment and timely filing
Medicaid fee-for-service: 180 days from the later of date of service or eligibility decision for in-state claims without TPL, 365 days with TPL or for out-of-state providers (Billing Manual, Chapter 7). The Medicaid plans opened list 180 days. Citation: Nevada Medicaid Billing Manual, Chapter 7. Source
Not legal advice. Confirm statute details with counsel.
Nevada billing guide: codes and rates
This Nevada billing guide lists only codes and rates confirmed on official pages.
These are the Nevada-specific codes, modifiers and rate items confirmed on official pages.
| Code or item | What to know |
|---|---|
| Nevada Medicaid fee schedule lookup | Nevada Medicaid directs providers to its Search Fee Schedule to check whether a code is payable and at what rate. Source |
| Children's behavioral health rate increase | Q1 2026 provider newsletter: Medicaid is raising pay for children's behavioral health services by up to 25%, retroactive to January 1, 2025. Source |
| Common professional claim denials | Web Announcement 3675 (7/16/2025) lists top denial reasons for June 2025 professional claims, including 2017 (member covered by an HMO/MCO: bill the plan), 3001 (prior authorization not found), 5035 (exact duplicate) and 676 (timely filing). Source |
| Prior authorization reconsideration | Reconsideration requests for adverse prior authorization decisions must be submitted within 30 days of the decision (Q1 2026 provider newsletter). Source |
Nevada billing guide: what changed, newest first
Check this Nevada billing guide update log before you rely on an older rule.
| Date | What changed | Source |
|---|---|---|
| 2026-10-08 | CMS Telehealth FAQ updated: Medicare telehealth flexibilities run through 12/31/2027; the in-person visit requirement for mental health telehealth applies after 12/31/2027. | Source |
| 2026-10-08 | Nevada Medicaid Billing Manual cover and change history show a 10/08/2026 revision (the billing information page lists the manual as updated 10/22/2026). | Source |
| 2026-08-17 | SilverSummit published a provider HR1 toolkit stating Nevada Medicaid work requirements start January 1, 2027 for certain expansion members aged 19 to 64, with letters going out in September 2026. | Source |
| 2026-04-01 | Nevada Medicaid Q1 2026 provider newsletter: children's behavioral health rate increase of up to 25% retroactive to 1/1/2025; Battle Born State Plan contracting requirement waived through 12/31/2026. | Source |
| 2026-01-27 | Web Announcement 3815 (issued 1/9/2026, updated 1/27/2026): support for providers during the rural Medicaid managed care transition; patients can keep seeing providers not yet contracted with their plan, and plans can use single case agreements. | Source |
| 2026-01-01 | Nevada Medicaid managed care became statewide, including rural areas for the first time; Health Plan of Nevada Medicaid narrowed to Clark County only; CareSource and SilverSummit serve rural Nevada. | Source |
| 2025-09-30 | Nevada Division of Insurance dated its draft MHPAEA non-quantitative treatment limits summary report on Aetna Health, Inc. (file posted as 11.10.25). | Source |
How do I bill mental health claims in Nevada?
These answers come from the same sources as the rest of this Nevada billing guide.
Nevada Medicaid and Nevada Check Up are operated by the Nevada Health Authority (NVHA); the Division of Health Care Financing and Policy (DHCFP) name still appears on dhcfp.nv.gov pages. Since January 1, 2026, Medicaid managed care covers the whole state, including rural counties for the first time, with five plans (Anthem Blue Cross and Blue Shield Healthcare Solutions, CareSource, Health Plan of Nevada, Molina and SilverSummit); fee-for-service claims go to the Gainwell Technologies-run portal. Start with the member's payer type: Medicaid plan, Medicare Part B, a Blue Cross licensee or another commercial plan.
Questions about billing in Nevada
How long do I have to bill Nevada Medicaid fee-for-service claims?
Managed care plans set their own limits; the Medicaid plans we opened list 180 days.
Who do I bill for a Nevada Medicaid member in a managed care plan?
Bill the member's plan, not fee-for-service Medicaid. Error 2017 on a fee-for-service claim means the member's services are covered by an HMO/MCO. Since January 1, 2026 the five plans are Anthem, CareSource, Health Plan of Nevada (Clark County only), Molina and SilverSummit, and you can check a member's plan in the Provider Web Portal.
Who is the Blue Cross licensee in Nevada?
Anthem Blue Cross and Blue Shield is the trade name of Rocky Mountain Hospital and Medical Service, Inc. in Nevada, per Anthem's legal notice. Blue plans are independent licensees, so do not apply Nevada Anthem rules to Anthem in other states or to other Blue plans.
Does Nevada require insurers to pay for telehealth mental health care the same as in person?
Yes for counseling or treatment of a mental health condition or substance use disorder. Senate Bill 119 (2023), effective July 1, 2023, requires reimbursement to match in-person payment for that care, including when it is audio-only. It applies to insurers, health plans and the Medicaid State Plan.
Does MCM South bill for practices in Nevada?
MCM South currently serves ten states; request a quote to ask about Nevada.
Sources for the Nevada billing guide
Last checked October 25, 2026. Every source below was opened and read on that date.
- Nevada Medicaid billing information (portal, fee schedule, Gainwell), checked October 25, 2026
- Nevada Medicaid Billing Manual (Chapter 7, rev. 10/08/2026), checked October 25, 2026
- Nevada Medicaid Web Announcement 3753 (10/24/2025), checked October 25, 2026
- Nevada Medicaid Web Announcement 3815 (1/9/2026, updated 1/27/2026), checked October 25, 2026
- Nevada Medicaid Web Announcement 3675 (7/16/2025), checked October 25, 2026
- Nevada Medicaid Web Announcement 2965 (12/22/2022), checked October 25, 2026
- Nevada Medicaid Web Announcement 2531 (6/25/2021), checked October 25, 2026
- Nevada Medicaid Q1 2026 provider newsletter (file dated 2026-04-01), checked October 25, 2026
- DHCFP tribal letter on new MCO procurement (6/10/2025), checked October 25, 2026
- DHCFP health and dental plans page, checked October 25, 2026
- Nevada Medicaid members page, checked October 25, 2026
Related guides
- State & Regional Billing Guides hub
- In-network vs out-of-network credentialing
- Credentialing and network status
- Mental health parity explained
- Medicaid managed care billing
- Medicare behavioral health billing
- Timely filing in the billing glossary
- Who we serve
- Colorado insurance companies contact guide
- California insurance companies contact guide
- Washington insurance companies contact guide
Billing in Nevada? Let us handle the payer calls.
MCM South bills only mental and behavioral health, for psychotherapists and psychiatrists, in solo and medium-size practices. We currently serve ten states; request a quote to ask about Nevada.
MCM South currently serves practices in ten states: Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois.