Molina Healthcare of Nevada is one of the five Nevada Medicaid health plans and covers Nevada Medicaid and Nevada Check Up members statewide from January 1, 2026. Its 2026 provider manual (revised June 2026) is silent on applied behavior analysis: it does not list ABA, autism or behavior analysts anywhere except naming the Behavior Analyst Certification Board among the boards it accepts for credentialing. The practical result is that Nevada’s state ABA rules (MSM 3700, the PT 85 billing guide and FA-11E/FA-11F) are the baseline, and code-level prior-authorization rules must be checked in Molina’s lookup tool.
Molina’s Nevada prior-authorization page says office visits to participating providers need no PA, that “Molina requires PA for certain services,” and that providers should “See which services need PA with the prior authorization lookup tool.” From February 1, 2026, “providers must submit medical benefit PA requests through Availity provider portal, as Molina no longer accepts fax submissions.” The 2026 manual adds that Molina “does not retroactively authorize services that require PA; with the exception of extenuating circumstances,” that decisions are made “no later than contractual and regulatory requirements,” and that after a denial the provider may schedule a peer-to-peer “up to five (5) business days from the denial notification.” Because the manual says nothing about ABA, treat the state rules as the floor: assessments once per 180 days without PA in fee-for-service, treatment under PA with FA-11E content, and the 12-hour and 40-hour limits. 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).[2][1][4][6][5]
For claims, Molina lists clean-claim timely filing of “180 days (in state Providers)” and “365 days (out of state Providers),” processes clean claims “within 30 days after receipt,” and says “Medicaid is always the payer of last resort.” Telehealth claims must follow “NV Medicaid MSM Chapter 3400-Telehealth and NV Medicaid Telehealth Billing Instructions.”[2][1][4][6][5]
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.[13][14][4]
The questions that decide whether a family can start with Molina Healthcare of Nevada (Medicaid), and what they have to bring. Each maps onto something intake should ask on the first call.
Molina publishes no ABA age rule. No age limit. Nevada Medicaid covers ABA for “Medicaid eligible individuals of all ages” (MSM 3704.1, effective April 1, 2024), with members under 21 also covered through EPSDT.[4][1]
Molina publishes nothing of its own. The state rule: the diagnosis is “completed only one time” and repeat testing “should not be performed when full criteria were previously met” (MSM 3704.2A(6)(b)).[4][1]
Molina publishes nothing of its own. The state’s FA-11F must be signed by a physician, physician assistant, APRN or psychologist acting within scope.[7][4]
Molina publishes nothing of its own. Nevada Medicaid’s list (MSM 3704.2A(5)(f), FA-11F): ADOS-2, CARS-2, GARS-3 or an FASD diagnostic category, with the score on FA-11F; if DSM-5 criteria alone are used, the specific criteria met must be documented.[4][7]
Molina publishes nothing different. Nevada Medicaid’s rule (MSM 3704.1, FA-11F): ABA “must be rendered according to the written orders of” a physician, physician assistant, psychologist or APRN/NP, who certifies the diagnosis on FA-11F with the first request.[4][7]
Molina tells providers to bill telehealth under MSM 3400 and the Nevada Medicaid Telehealth Billing Instructions and publishes no ABA-specific rule. Nevada Medicaid’s rule: MSM 3403 gives telehealth “parity with in-person health care services,” requires the originating site to be in Nevada and lists only personal care, home health and private duty nursing as in-person-only; NRS 422.2721 bars extra prior authorization for telehealth. Bill POS 02 or 10 with modifier 95 (audio-video) or 93 (audio-only). The clinician needs a Nevada license (NRS 629.515). No Nevada ABA document lists which ABA codes may be delivered remotely.[1][8][9][10][14]
“Medicaid is always the payer of last resort and Providers shall make reasonable efforts to determine the legal liability of third parties”; secondary claims are due within 180 days of the primary payer’s final determination.[1][12]
Molina says it decides “no later than contractual and regulatory requirements” and publishes no number. The federal managed-care limit is 7 calendar days for standard requests in rating periods starting on or after January 1, 2026, 72 hours expedited.[1][11]
Ask the plan: Molina Nevada utilization management: ask the standard turnaround for ABA requests.
Coverage decides whether Molina Healthcare of 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.
Molina publishes no ABA supervision rule. Nevada Medicaid’s rule (MSM 3704.3A, MSM 3704.2A(1)(j)): supervision follows NRS 641D.610, “must be overseen by a Licensed Psychologist, BCBA-D or BCBA who has experience in the treatment of autism,” may be delivered by a BCaBA at their direction, and is capped at 20% of direct therapy hours unless clinical documentation supports more. MSM 3600 requires MCOs to provide services with the same amount, duration and scope as fee-for-service.[4][5][1]
Molina publishes no ABA limits. Nevada Medicaid’s limits (MSM 3704.2A(4); PT 85 billing guide): 12 hours of ABA per provider per day, 40 hours per recipient per week; focused 15–25 and comprehensive 25–40 hours a week counting 97153, 97155 and 0373T together; 97151 one 16-unit and 97152/0362T one 4-unit session per 180 days; 97156 4 units a week. Limits may be exceeded with prior authorization and documented medical necessity.[4][6][1]
Molina publishes no ABA note rule. Nevada Medicaid’s rule (MSM 3704.4G): a progress note for each day of service with the recipient’s name, place of service, date, actual start and end times, the name and credentials of the provider who delivered the service, and “The signature of the provider who delivered the service.”[4][5]
Molina publishes no ABA setting rule. Nevada Medicaid’s rule (MSM 3704.1, 3704.2A(8)): ABA may be delivered in a clinic or office, the community or the home, and in “the natural setting (i.e. home, school and community-based settings, including clinics)”; resorts, spas, camps, education services, respite and child care are not covered. Telehealth is billed POS 02 or 10.[4][10]
Molina does not publish an ABA rule; check each code in its prior authorization lookup tool and submit through Availity (no fax since February 1, 2026). The state requires PA for ABA treatment but not assessments.
180 days for in-state providers and 365 days for out-of-state providers; clean claims are processed within 30 days.
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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