CareSource joined Nevada Medicaid with the statewide managed care contracts that started January 1, 2026, and NVHA lists it among the five health plans. Unlike most Nevada plans, it publishes two Nevada-specific ABA policies, both effective January 1, 2026: a medical policy (NV MCD-MM-1846) and a reimbursement policy (NV MCD-PY-1695). Both say CareSource follows the Medicaid Services Manual and that state guidance “supersedes this policy,” so they mostly restate MSM 3700, with a few CareSource additions worth knowing at intake.
Medical necessity review is required “initially with a baseline and then, again, every 6 months.” The initial request must document the diagnosis and the ordering practitioner (physician, physician assistant, the Nevada Board of Psychological Examiners licensee, or APRN/NP), a treatment regimen “designed and signed by a qualified ABA provider,” and standardized tools (ADOS-2, CARS-2, GARS, or an FASD diagnostic category; DSM criteria alone need the specific criteria documented). CareSource adds one dated rule the state does not have: if the diagnostic evaluation “was completed more than 24 months from date of request,” send written documentation, such as a provider letter, describing DSM symptoms present within the past year. The treatment record must be signed by the parent or guardian “and submitted to CareSource prior to claim submission. Claims will not be accepted without accompanying, signed treatment documentation.”[3][4][7]
The reimbursement policy restates Nevada’s limits (focused 15–25, comprehensive 25–40 hours a week; 12 hours a day per provider; 40 hours a week per member; supervision up to 20% of direct hours) and adds billing rules: a BCBA doing one-to-one treatment bills it as treatment, not 97155; a supervising BCBA “must review and approve the data collection and progress notes completed by a BCaBA or RBT under supervision prior to submitting a claim”; RBTs need ongoing supervision of at least 5% of their monthly service hours; and new RBTs get 60 days from hire to finish BACB credentialing. Each claim line must cover a single date of service, CareSource applies CMS Medicaid MUEs, and a unit counts once the midpoint of 15 minutes is passed. Nevada’s managed-care rules give members (or a provider acting with the member’s written permission) 60 calendar days from the notice of adverse benefit determination to appeal to the plan, allow one level of internal appeal, and require a standard appeal decision within 30 calendar days (expedited within 72 hours); after the plan’s appeal, the member may request a State Fair Hearing (MSM 3604).[3][4][7]
Not without a Nevada license. NRS 641D.900 bars anyone from engaging “in the practice of applied behavior analysis unless he or she is licensed or registered as required by the provisions of this chapter.” Telehealth does not get around that: NRS 629.031 counts “A behavior analyst, assistant behavior analyst or registered behavior technician” as a provider of health care, and NRS 629.515 says that before a provider at a distant site “may use telehealth to direct or manage the care or render a diagnosis of a patient who is located at an originating site in this State,” the provider “must hold a valid license or certificate to practice his or her profession in this State.” A BCBA directing a Nevada child’s program from another state is therefore treated as practicing in Nevada and is “subject to the laws and jurisdiction of the State of Nevada.” The fast path is licensure by endorsement under NRS 641D.340: a behavior analyst who holds “a corresponding valid and unrestricted license as a behavior analyst” in another state or D.C. may apply, and unless the Board denies for good cause it must issue the license within 45 days of the application or 10 days after the fingerprint background report, whichever is later. Payers add their own layer: credential the clinician with each plan before billing.[12][13][3]
CareSource’s own telehealth section warns providers to consider “interstate licensure challenges” and reserves the right to request supervision documentation, “particularly related to telehealth services.”[12][13][3]
Federal Medicaid rules set the payment floor for every managed care plan: a state’s contract with an MCO "must provide that the organization will meet the requirements of § 447.45(d)(2) and (d)(3)" (42 CFR 447.46) — pay 90 percent of clean claims from practitioners within 30 days of receipt and 99 percent within 90 days — unless the plan and the provider agree in writing to an alternative schedule stipulated in the contract. A "clean claim" is one that "can be processed without obtaining additional information from the provider of the service or from a third party" (42 CFR 447.45(b)). CareSource’s Nevada timely-filing, corrected-claim and secondary-claim limits were not in the documents read for this guide (its ABA medical and reimbursement policies are silent on them); take them from your CareSource agreement or Provider Services.[1][2]
The questions that decide whether a family can start with CareSource Nevada (Medicaid), and what they have to bring. Each maps onto something intake should ask on the first call.
None: “ABA therapy is a medical necessary treatment for any age for conditions recognized as medically necessary”; members under 21 are evaluated under EPSDT.[3]
If the submitted diagnostic evaluation “was completed more than 24 months from date of request,” CareSource needs written documentation (for example a provider letter) describing DSM symptoms present within the past year that require treatment. Continuation requests every 6 months must show the diagnosis persists.[3]
The diagnosis must be “rendered according to the written orders of” a physician, physician’s assistant, Nevada Board of Psychological Examiners licensee, or APRN/NP; the initial behavior assessment is by “a fully credentialed BCBA with state licensure.”[3]
ADOS-2, CARS-2, GARS-2 (as printed in the policy; the state form now lists GARS-3) or the FASD diagnostic category; if DSM criteria alone are used, document the specific criteria met.[3][15]
Yes: written orders from a physician, physician’s assistant, psychologist or APRN/NP, and a treatment regimen designed and signed by a qualified ABA provider, must be documented before services.[3]
Allowed: “Telemedicine services are reimbursed in the same manner and subject to the same limits as in-person, face-to-face service delivery.” Providers must document clinical appropriateness and consider interstate licensure, and CareSource may request supervision documentation for telehealth. It lists no ABA codes excluded from telehealth. The clinician needs a Nevada license (NRS 629.515).[4][3][13]
“When a member has other insurance, Medicaid is always the payer of last resort. CareSource will not pay more than the Medicaid rate totals for service. Primary payer must provide evidence of determinations for consideration of Medicaid coverage for services.”[4][11]
CareSource’s ABA policies publish no decision timeframe. The federal managed-care limit applies: 7 calendar days for standard requests for rating periods starting on or after January 1, 2026 (extendable by 14), 72 hours for expedited.[10][3]
Ask the plan: CareSource Nevada Provider Services: ask the standard turnaround for ABA requests and the recommended lead time before an authorization ends.
Coverage decides whether CareSource Nevada (Medicaid) pays. These decide whether the claim survives: how sessions must be staffed and supervised, what may be billed concurrently, the per-day ceilings, who signs the note, where the service is payable, and whose NPI the claim goes out under.
RBT services “must be supervised by a qualified RBT supervisor (ie, BCBA, BCBA-D, licensed psychologist …) and obtain ongoing supervision for a minimum of 5% of the hours spent providing ABA services per month”; BCaBAs must be supervised by a BCBA, BCBA-D or qualified psychologist. Supervision units are capped at 20% of direct therapy hours unless documentation supports more, and the licensed psychologist, BCBA-D or BCBA “is responsible for all aspects of clinical direction, supervision, and case management.”[4][3]
Providers are limited to 12 hours of ABA a day and members to 40 hours a week; focused 15–25 and comprehensive 25–40 hours a week for 97153, 97155 and 0373T combined, exceedable with prior authorization; 97151 one 16-unit session and 97152 one 4-unit session per 180 days; CMS Medicaid MUEs apply.[4]
A progress note is required “for each day services were delivered” with the MSM 3704.4G elements (including the rendering provider’s name, credentials and signature) “in addition to identification of all present during the session(s),” and the supervising BCBA must review and approve BCaBA and RBT data and notes before the claim is submitted.[4][6]
Services are delivered “in the least restrictive, most normative setting possible, including a medical professional clinic/office, a community environment or in the member’s home,” and may be in individual or group (2–8) sessions in natural settings including school; education-related IDEA services, camps, resorts and other nonconventional settings are excluded.[3][4]
Not directly addressed. CareSource says a BCBA delivering one-to-one treatment without supervising a BCaBA or RBT “is not considered an adaptive behavior treatment with protocol modification service and must be billed as an ABA therapy treatment service,” but does not say whether 97153 and 97155 may be billed for the same minutes.[4]
Ask the plan: CareSource Nevada Provider Services: ask whether 97155 and the RBT’s 97153 may both be billed for the same time when the BCBA is directing the RBT.
Not stated beyond requiring “Appropriate modifiers indicating qualifications of staff delivering services.” The fee-for-service rule bills the NPI of the person who delivered the service with UD for BCaBA and RBT lines; confirm CareSource follows it.[4][8]
Ask the plan: CareSource Nevada Provider Services: ask whose NPI goes on RBT lines and which modifier is required.
Its state contract must hold it to the federal Medicaid standard: 90% of clean practitioner claims paid within 30 days of receipt and 99% within 90 days (42 CFR 447.46, 447.45), unless the provider contract sets an alternative schedule. Its own filing limit comes from the provider manual or your agreement.
No. Initial assessments and reassessments need no medical necessity review, limited to one every 180 days. Treatment is reviewed before it starts and every 6 months.
Yes, but if it is more than 24 months old, add a provider letter describing DSM symptoms present in the past year.
One common cause: CareSource will not accept ABA claims until it has the signed treatment documentation (parent or guardian signature). Each claim line must also be a single date of service.
Payer policies change frequently and vary by plan, state, and funding type. This guide was compiled from the sources above and last reviewed October 2026; it is general information, not billing, legal, or clinical advice. Always verify current requirements against the payer's live policy and a benefits check for the specific member.
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