Nevada Medicaid covers applied behavior analysis under its own chapter of the Medicaid Services Manual, MSM 3700, and since April 1, 2024 the benefit has no age ceiling: Medicaid “will reimburse for ABA rendered to Medicaid eligible individuals of all ages,” with members under 21 also covered through EPSDT. The covered conditions are autism spectrum disorder, fetal alcohol spectrum disorder, or any other condition for which ABA is recognized as medically necessary. The agency running it is now the Nevada Health Authority (NVHA); its fiscal agent and prior-authorization vendor is Gainwell Technologies.
Most children get Medicaid through a health plan. Managed care went statewide on January 1, 2026, and NVHA lists five Medicaid health plans: Anthem Blue Cross and Blue Shield, CareSource, Health Plan of Nevada, Molina Healthcare of Nevada and SilverSummit Healthplan. ABA is not carved out of those contracts, so the card decides who authorizes and pays. Children in foster care, people with disabilities, seniors and waiver members stay in fee-for-service, where the rules on this page apply directly.
MSM 3704.1 says Medicaid “will reimburse for ABA rendered to Medicaid eligible individuals of all ages,” for members under 21 “in accordance with” EPSDT. The behavior intervention must be medically necessary “to develop, maintain or restore to the maximum extent practical the functions of an individual with a diagnosis of ASD, FASD or other condition for which ABA is recognized as medically necessary,” and it “must be rendered according to the written orders of the Physician, Physician’s Assistant (NRS 630.271), Nevada Board of Psychological Examiners or an Advanced Practitioner Registered Nurse (APRN)/Nurse Practitioner (NP).” The age expansion came from SB 191 (2023): Web Announcement 3315 describes the MSM changes as allowing “the use of ABA services for all eligible Medicaid recipients, regardless of age.” The statute itself, NRS 422.27497, sets a narrower floor, requiring the State Plan to pay for behavior-analyst, assistant and RBT services “to recipients of Medicaid who are less than 27 years of age”; the manual goes further, and the manual is what Gainwell applies.[3][17][18][13][14][15][12]
From January 1, 2026 managed care covers rural as well as urban counties. NVHA’s health-plan page lists Anthem Blue Cross and Blue Shield (844-396-2329), CareSource (833-230-2058), Health Plan of Nevada (800-962-8074), Molina Healthcare of Nevada (833-685-2102) and SilverSummit Healthplan (844-366-2880). ABA does not appear among MSM 3600’s excluded or carved-out services, and the chapter requires each MCO to file an ABA report covering “members’ average wait times for ABA service appointments, the number of providers rendering ABA services.” MCOs must provide services “with the same timeliness, amount, duration, and scope” as fee-for-service. About 126,000 people stay in fee-for-service, including children in foster care, juvenile justice and child welfare, people with disabilities and waiver members.[3][17][18][13][14][15][12]
Screens and assessments need no PA; treatment does. MSM 3704.2B says adaptive behavior treatment and family behavior training (individual and group) require prior authorization “from the Quality Improvement Organization (QIO)-like vendor,” and that when a school has issued an IEP, Plan of Care or 504 plan, it “must accompany a request for ABA services.” Requests go through the Provider Web Portal on FA-11E (updated 07/13/2026), with FA-11F, the ASD Diagnosis Certification, attached to the first request only. FA-11F is signed by the ordering practitioner, who “must be a Physician, Physician’s Assistant, Advanced Practice Registered Nurse (APRN) or Psychologist,” and certifies the member is “Medicaid Eligible (any age),” with the diagnostic tool and score (ADOS-2, CARS-2, GARS-3, an FASD diagnostic category, or DSM-5 criteria with documentation of the criteria met). FA-11E must be signed by the parent or guardian, who agrees to the parent responsibilities in MSM 3700.[3][7][8][4][9]
Timing comes from the PT 85 billing guide (updated 07/27/2026). Submit the initial request “no more than 15 business days before and no more than 15 calendar days after the start date of service.” A continued-service request “must be received by Nevada Medicaid by the last authorized date,” ideally 5 to 15 days before. Unscheduled revisions go in during the current period, before the extra units are delivered; a retrospective request is due within 90 days of the eligibility decision. Incomplete requests are pended, and the submitter “will have five business days to supply the missing information, or a technical denial will be issued.” A denied or reduced request can get a peer-to-peer (email within 10 business days of the decision) and a reconsideration on FA-29B; ABA reconsiderations “can be requested at any point within the date range requested on the PA,” unlike the 30-day limit for most services. Authorization “does not guarantee payment.”[3][7][8][4][9]
NVHA publishes the ABA rates by specialty (310 BCBA, 311 psychologist, 312 BCaBA, 314 RBT; BCaBA and RBT lines carry modifier UD). The PT 85 Reimbursement Schedule with rate data as of 07/2026 (last rate review 2023) pays, per 15 minutes: 97151 $29.14 (BCBA) or $17.54 (psychologist); 97152 $35.09 (BCBA or psychologist), $21.05 (BCaBA) or $15.60 (RBT); 97153 $30.10 (BCBA or psychologist), $18.06 (BCaBA) or $13.01 (RBT); 97154 $7.60 (BCBA), $7.14 (psychologist), $7.50–$7.60 (BCaBA) or $7.08–$7.14 (RBT); 97155 $30.10 (BCBA or psychologist), $19.92 (BCaBA) or $20.50 (RBT); 97156 $21.32 (BCBA) or $21.17 (psychologist); 97157 $11.70; 97158 $14.28; 0362T $35.09 (psychologist) or $31.50 (BCaBA); 0373T $25.74 (BCBA), $19.07 (psychologist), $20.50 (BCaBA) or $20.21 (RBT). Most BCBA and psychologist lines date from 03/10/2025; most BCaBA and RBT lines from 2022–2023. The schedule notes that codes priced at $0.00 pay 62% of usual and customary charges. MCOs pay their own contracted rates; CareSource, for one, says its maximum allowable for a service “is the same for all ABA providers.”[5][6][4][25]
Bill each service “with the National Provider Identifier (NPI) of the actual provider of the service, not the supervising clinician,” and add modifier UD on claims and PA requests for BCaBA (specialty 312) and RBT (specialty 314) services. Date-span billing is not permitted, and the NPI of the Medicaid-enrolled ordering or referring practitioner must be on the claim or it will deny. Only PT 85 (ABA), PT 60 (School Health Services) and PT 47 (tribal and IHS clinics) may bill ABA codes, and a PT 85 group NPI “must be unique to the group.” Timely filing: in-state claims without other insurance “must be received within 180 days of the date of service or date of eligibility decision”; claims with other insurance and claims from out-of-state providers have 365 days. A denied claim can be appealed through Secure Correspondence “no later than 30 calendar days from the date on the remittance advice.”[1][2][4][3][9][10][11]
Telehealth is billed with POS 02 (outside the home) or 10 (in the home) plus modifier 95 for real-time audio-video or 93 for audio-only; the home cannot bill the Q3014 facility fee. MSM 3400 gives telehealth “parity with in-person health care services” and lists only personal care, home health and private duty nursing as in-person-only; neither MSM 3400 nor the PT 85 guide names an ABA code that may not be delivered remotely. Neither MSM 3700 nor the PT 85 guide mentions electronic visit verification for ABA; Nevada Medicaid’s EVV program page is labelled EVV-PCA. ABA cannot be paid on the same day as Basic Skills Training or Psychosocial Rehabilitation (MSM 3704.2C(16)).[1][2][4][3][9][10][11]
Federal rules bind Nevada Medicaid’s own fee-for-service payments: the agency "must pay 90 percent of all clean claims from practitioners, who are in individual or group practice or who practice in shared health facilities, within 30 days of the date of receipt" and 99 percent within 90 days, with the date of receipt being the agency’s date stamp and the date of payment the date of the check or other payment (42 CFR 447.45(d)(2), (3), (5), (6)). The same rule makes 12 months from the date of service the outer limit any state may allow for filing (42 CFR 447.45(d)(1)). Managed care plans are held to the same 90/99 percent clean-claim standard through their state contracts (42 CFR 447.46).[1][2][4][3][9][10][11]
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.[19][20][3][11][9]
Medicaid adds its own gate: MSM 3704.3 recognizes a behavior analyst only if the BCBA is “licensed by the Nevada State Board of Applied Behavior Analysis under NRS 641D.300,” and the same applies to BCaBAs (licensed) and RBTs (registered). MSM 3400 requires the distant-site provider to be an enrolled Medicaid provider and the originating site (the member) to be in Nevada. Out-of-state providers get 365 days for timely filing.[19][20][3][11][9]
The questions that decide whether a family can start with Nevada Medicaid, and what they have to bring. Each maps onto something intake should ask on the first call.
None. Medicaid “will reimburse for ABA rendered to Medicaid eligible individuals of all ages” (MSM 3704.1, April 1, 2024), and FA-11F certifies the member is “Medicaid Eligible (any age).” Members under 21 are also covered through EPSDT. (NRS 422.27497 itself guarantees the benefit for recipients under 27; the manual covers all ages.)[3][8][18]
No recency rule for the diagnosis: “The diagnosis is to be completed only one time. Repeat testing should not be performed when full criteria were previously met” (MSM 3704.2A(6)(b)). FA-11F goes with the initial request only. For continued requests, FA-11E asks for baseline and progress over the previous 90 days.[3][8][7]
FA-11F must be signed by the practitioner ordering ABA, who “must be a Physician, Physician’s Assistant, Advanced Practice Registered Nurse (APRN) or Psychologist acting within their scope of practice,” and records the diagnosis date and tool. MSM 3704.1 likewise requires written orders from a physician, PA, psychologist or APRN/NP. Nevada’s ABA licensure statute excludes diagnosis from the practice of ABA (NRS 641D.080).[8][3][19]
MSM 3704.2A(5)(f) lists ADOS-2, CARS-2, GARS-3 and the FASD diagnostic category. “If … (DSM-5) criteria alone are used as the sole basis for diagnosis the provider must submit documentation of the specific DSM-5 criteria that were met.” FA-11F asks for the tool, score and subscale scores; the PT 85 guide says the diagnosis must use “a widely accepted diagnostic test (generally those listed on the FA-11F form)” or a DSM-5 clinical evaluation.[3][8][4]
Yes. ABA "must be rendered according to the written orders of the Physician, Physician's Assistant (NRS 630.271), Nevada Board of Psychological Examiners or an Advanced Practitioner Registered Nurse (APRN)/Nurse Practitioner (NP)" (MSM 3704.1). "The treatment regimen must be designed and signed off on by the qualified ABA provider." Nevada publishes its own order form. FA-11F, "Practitioner Certification Ordering ABA Services," must be completed by "a Physician, Physician's Assistant, Advanced Practice Registered Nurse (APRN) or Psychologist acting within their scope of practice." It certifies the diagnosis and the need for ABA, names the diagnostic tool and score (ADOS-2, CARS-2, GARS-3, an FASD category, or DSM-5 criteria with documentation), and carries the practitioner's name, credentials, NPI, signature and date of diagnosis. FA-11F goes "with initial requests for ABA services along with FA-11E," and is not resubmitted with continued-service requests. Nevada sets no renewal date because "The diagnosis is to be completed only one time." In practice the diagnosing physician, APRN, PA or psychologist completes FA-11F at or after the diagnostic evaluation. The ordering practitioner must be Medicaid-enrolled. "For any services or supplies that are ordered, prescribed or referred, the NPI of the Nevada Medicaid-enrolled Ordering, Prescribing or Referring (OPR) provider must be included on Nevada Medicaid/Nevada Check Up claims or those claims will be denied." On electronic claims, report it in Loop 2310A; on the Provider Web Portal, use the Referring/Ordering Provider ID field.[3][8][4]
Allowed on parity. MSM 3403 says Nevada Medicaid reimburses telehealth, “Services provided via telehealth have parity with in-person health care services,” the originating site must be in Nevada, and the distant-site provider must be Medicaid-enrolled; the only services MSM 3403.6 requires in person are personal care, home health and private duty nursing. NRS 422.2721 requires the State Plan to pay for telehealth “to the same extent as though provided in person” and bars extra prior authorization for telehealth. Bill POS 10 (home) or 02 plus modifier 95 (audio-video) or 93 (audio-only). No Nevada ABA document lists which ABA codes are clinically appropriate remotely, and the clinician must hold a Nevada license (NRS 629.515).[11][18][10][20]
Nevada publishes no ABA decision clock for fee-for-service. The federal floor applies: since January 1, 2026 the state agency must decide a standard request “in no case later than 7 calendar days after receiving the request” and an expedited one “in no case later than 72 hours.” On Nevada’s side, a pended request gives the provider five business days to send missing information before a technical denial; reconsideration results come within 30 calendar days. Continued-service requests must arrive by the last authorized date (5–15 days early is recommended). MCO members follow their plan’s clock under 42 CFR 438.210(d) (7 calendar days for rating periods starting on or after January 1, 2026).[22][4][9][27]
“Medicaid is the payer of last resort and must be billed after all other payment sources,” and providers must “Always follow other payers’ billing requirements. If the other payer denies a claim because you did not follow their requirements, Medicaid will also deny the claim.” Claims with other insurance have 365 days for timely filing. A provider may not bill the family for the primary plan’s copayment or for the difference between billed and paid amounts. The rule rests on 42 CFR 433.139.[9][23]
Coverage decides whether 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.
Supervision follows NRS 641D.610 and “must be overseen by a Licensed Psychologist, BCBA-D or BCBA who has experience in the treatment of autism, although the actual supervision may be provided by a BCaBA at their direction” (MSM 3704.3A). “The maximum number of units that can be used for supervision is 20% of the total number of hours of direct therapy services provided, unless clinical documentation is submitted that supports a need for additional units” (MSM 3704.2A(1)(j)); the PT 85 guide repeats that supervision is allowed up to 20% of treatment hours. The treatment plan must be developed and approved by a licensed psychologist, BCBA-D or BCBA, who “is responsible for all aspects of clinical direction, supervision, and case management.”[3][4][19]
Providers are limited to 12 hours of ABA per day and recipients to 40 hours per week (MSM 3704.2A(4)); the PT 85 guide applies the 40-hour cap to 0373T and 97153–97158 “regardless of NPI” and the 12-hour cap per servicing provider to 0362T, 0373T, 97151–97153 and 97155–97156. Delivery-model limits count 97153, 97155 and 0373T together: focused 15–25 hours a week, comprehensive 25–40. Code limits: 97151 one 16-unit session and 97152/0362T one 4-unit session per 180 days; 97156 4 units a week; 97157 one 4-unit session a month. “All session limits may be exceeded with prior authorization and documented medical necessity.” Those are program limits enforced through the authorization. Separately, the PT 85 guide (updated 10/13/2026) says Nevada’s MMIS “uses NCCI Edits in the processing of Nevada Medicaid claims” and loads CMS’s quarterly medically unlikely edits; CMS’s published Medicaid MUE table for dates of service October 1 – December 31, 2026 sets per-provider, per-member, per-day values of 97151 32 units, 97152 16, 97153 32, 97154 18, 97155 24, 97156 16, 97157 16, 97158 16, 0362T 16 and 0373T 32.[26][3][4]
A progress note is required for each day services were delivered, legible, with the recipient’s name (and whether it was group), place of service, date, actual start and end times, “The name of the provider who delivered the service,” their credentials and “The signature of the provider who delivered the service” (MSM 3704.4G). No signing deadline is stated.[3]
ABA may be delivered “in a medical professional clinic/office, within a community environment or in the recipient’s home,” in the least restrictive setting (MSM 3704.1), and in “the natural setting (i.e. home, school and community-based settings, including clinics)” (MSM 3704.2A(8)). IEP/IFSP services may be billed by enrolled providers, with School Health Services under MSM 2800. A June 2024 DHCFP letter confirms ABA can be delivered in a PRTF or RTC. Not covered: resorts, spas and camps, education services, respite and child care. Telehealth uses POS 02 or 10.[3][16][10]
“Each service provided must be billed with the National Provider Identifier (NPI) of the actual provider of the service, not the supervising clinician.” BCBAs (specialty 310), psychologists (311), BCaBAs (312) and RBTs (314) enroll under PT 85, and BCaBA and RBT claims and PA requests “must include modifier UD.”[4][3]
Not stated. The PT 85 guide’s “Do Not Report” lists for 97153 and 97155 do not name each other, and Nevada Medicaid applies CMS NCCI procedure-to-procedure edits and MUEs, but no Nevada source read says whether 97153 and 97155 may be billed for the same clock time.[4]
Blocked on: Gainwell Provider Services (Nevada Medicaid), or the CMS Medicaid NCCI PTP tables the PT 85 guide points to (cms.gov/medicare/coding-billing/ncci-medicaid); for MCO members, the member’s plan.
Yes. Since April 1, 2024, MSM 3700 covers ABA for Medicaid members of all ages with ASD, FASD or another condition for which ABA is medically necessary. Members under 21 are also covered through EPSDT.
No. Initial assessments and reassessments need no PA, limited to one every 180 days (97151 up to 16 units; 97152 and 0362T up to 4). Treatment needs PA on FA-11E, with FA-11F on the first request.
No. ABA is a benefit of the five health plans (Anthem, CareSource, Health Plan of Nevada, Molina, SilverSummit), which went statewide on January 1, 2026. Members outside managed care use fee-for-service through Gainwell.
Per 15 minutes on the 07/2026 PT 85 schedule: BCBA 97151 $29.14, 97153 and 97155 $30.10, 97156 $21.32; RBT (UD) 97153 $13.01; BCaBA (UD) 97153 $18.06. The health plans pay contracted rates.
The person who delivered the service, not the supervisor. RBT and BCaBA lines also carry modifier UD, and the ordering practitioner’s enrolled NPI must be on the claim.
180 days from the date of service (or eligibility decision) for in-state claims without other insurance; 365 days with other insurance or for out-of-state providers. Claim appeals are due within 30 days of the remittance advice.
Only with a Nevada license. NRS 629.515 requires a Nevada license for telehealth to a patient in Nevada, and MSM 3700 recognizes only BCBAs licensed by the Nevada Board of Applied Behavior Analysis. Licensure by endorsement (NRS 641D.340) is the fast path for analysts already licensed elsewhere.
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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