---
title: "Nevada Medicaid ABA coverage: the intake guide."
url: "https://carelu.com/payers/nevada-medicaid"
markdown_url: "https://carelu.com/payers/nevada-medicaid.md"
state: NV (Nevada)
payer: Nevada Medicaid
kind: State Medicaid program
description: "How Nevada Medicaid covers ABA: all ages under MSM Chapter 3700, no prior authorization for assessments, FA-11E/FA-11F for treatment, 12-hour and 40-hour limits, published PT 85 rates, five statewide MCOs from 2026, and Nevada behavior-analyst licensure."
last_reviewed: October 2026
---

# Nevada Medicaid ABA coverage: the intake guide.

_Payer Guide · Nevada Medicaid · Last updated October 2026 · 24 primary sources_

> ABA for Medicaid members of any age (MSM 3700); no PA on assessments; five MCOs statewide from 2026; published PT 85 rates.

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.

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment**: No. “Behavior initial assessment and re-assessments do not require prior authorization,” limited to one every 180 days unless prior authorized (MSM 3704.2B); the PT 85 guide lists 97151 (16 units), 97152 and 0362T (4 units each) per 180 days as “Not required” [3][4]
- **Prior auth for treatment**: Yes. Adaptive behavior treatment (individual and group) and family training require prior authorization from the QIO-like vendor (Gainwell), requested on FA-11E (plus FA-11F for the first request) through the Provider Web Portal [3][4][7]
- **Autism diagnosis required?**: Yes: an established diagnosis of ASD, FASD, or another condition for which ABA is recognized as medically necessary, documented once on FA-11F (MSM 3704.2A(6)(b)); claims carry F84.0, Q86.0 or the other qualifying diagnosis [3][8][4]

## At a glance

- **Covers ABA?:** Yes, for Medicaid members of any age (MSM 3704.1; age limits removed April 1, 2024)
- **Structure:** Five MCOs statewide from 1/1/2026 (Anthem, CareSource, Health Plan of Nevada, Molina, SilverSummit); ABA is an MCO benefit; FFS for excluded groups
- **Assessment PA:** None: 97151 (16 units), 97152 and 0362T (4 units) once per 180 days
- **Treatment PA:** FA-11E + FA-11F (initial) via the Provider Web Portal; Gainwell PA line (800) 525-2395
- **Hour limits:** Focused 15–25 hrs/wk, comprehensive 25–40 hrs/wk; 40 hrs/wk per recipient; 12 hrs/day per provider; supervision up to 20%
- **FFS rates (per 15 min):** BCBA: 97151 $29.14 · 97153 $30.10 · 97155 $30.10 · 97156 $21.32; RBT (UD): 97153 $13.01 (07/2026 schedule)
- **Licensure:** Required: behavior analysts and BCaBAs licensed, RBTs registered, by the Nevada Board of Applied Behavior Analysis (NRS 641D)

## Who is covered, for what, and through whom

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]

## Authorization: FA-11E, FA-11F and the Gainwell timelines

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]

## What does Nevada Medicaid pay for ABA? The PT 85 fee schedule

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]

## Claims operations: NPI, timely filing, telehealth and appeals

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]

## Can an out-of-state BCBA treat a Nevada Medicaid member, including by telehealth?

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]

## Intake gates

The questions that decide whether a family can start with Nevada Medicaid, and what they have to bring.

- **Age limit**: 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]
- **Diagnosis recency**: 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]
- **Who may diagnose**: 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]
- **Diagnostic tools required**: 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]
- **Referral required?**: 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]
- **Telehealth**: 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]
- **Prior-auth decision time**: 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]
- **Other insurance (who pays first)**: “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]

## Delivery and billing rules

Coverage decides whether Nevada Medicaid pays. These decide whether the claim survives: staffing and supervision, concurrent billing, per-day ceilings, who signs the note, where the service is payable, and whose NPI the claim goes out under.

- **Supervision**: 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]
- **Daily limits / MUEs**: 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]
- **Session-note signature**: 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]
- **Place of service**: 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]
- **Bill as provider**: “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]
- **Concurrent billing (97153 + 97155):** Not published / unverified. Verify via: 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. [4]

## What intake should collect for Nevada Medicaid

- **Which Medicaid card:** Anthem, CareSource, Health Plan of Nevada, Molina, SilverSummit, or fee-for-service. The plan owns authorization, credentialing and payment.
- **Diagnosis + tool score:** ASD (or FASD) with an ADOS-2, CARS-2 or GARS-3 score, or documented DSM-5 criteria. FA-11F records it once; repeat testing is not required.
- **Ordering practitioner:** Physician, PA, APRN or psychologist who signs FA-11F; their Medicaid-enrolled NPI goes on the claim.
- **IEP / 504 plan:** If the school issued one, it must accompany the ABA request.
- **Parent signature:** FA-11E and the treatment plan need it; a parent or designated adult must be present for home-based training and supervision visits.
- **Other insurance:** Medicaid pays last; follow the primary’s rules or Medicaid denies too. Claims with other insurance have 365 days.

Free verification-call checklist (PDF): https://carelu.com/downloads/aba-verification-call-checklist.pdf

## Common questions

### Does Nevada Medicaid cover ABA for adults?

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.

### Does the ABA assessment need prior authorization in Nevada Medicaid?

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.

### Is ABA carved out of Nevada Medicaid managed care?

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.

### What does Nevada Medicaid pay for ABA?

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.

### Whose NPI goes on a Nevada Medicaid ABA claim?

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.

### How long do I have to file a Nevada Medicaid ABA 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.

### Can a BCBA licensed in another state treat a Nevada Medicaid member by telehealth?

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.

## Primary sources

1. [42 CFR 447.45 — Timely claims payment (clean-claim definition; 90% in 30 days, 99% in 90 days) (eCFR)](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-447/subpart-A/section-447.45)
2. [42 CFR 447.46 — Timely claims payment by MCOs (eCFR)](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-447/subpart-A/section-447.46)
3. [Nevada Medicaid Services Manual Chapter 3700 — Applied Behavior Analysis (MTL 08/24, effective April 1, 2024; current)](https://www.nevadamedicaid.nv.gov/uploadedFiles/dhcfpnvgov/content/Resources/AdminSupport/Manuals/MSM/C3700/MSM_3700_24_04_01.pdf)
4. [Nevada Medicaid — Provider Type 85 Billing Guide, Applied Behavior Analysis (updated 10/13/2026)](https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT85.pdf)
5. [Nevada Medicaid — Provider Type 85 ABA Reimbursement Schedule (rate data as of 07/2026)](https://www.nevadamedicaid.nv.gov/siteassets/content/resources/rates/pt-85-fee-schedule-072026.xlsx)
6. [Nevada Medicaid — Fee Schedules (rates by provider type)](https://www.nevadamedicaid.nv.gov/Resources/Rates/FeeSchedules/)
7. [Nevada Medicaid Form FA-11E — Applied Behavior Analysis (ABA) Authorization Request (updated 10/14/2026)](https://www.medicaid.nv.gov/Downloads/provider/FA-11E.pdf)
8. [Nevada Medicaid Form FA-11F — ASD Diagnosis Certification for Requesting Initial ABA Services (updated 06/10/2025)](https://www.medicaid.nv.gov/Downloads/provider/FA-11F.pdf)
9. [Nevada Medicaid and Nevada Check Up Billing Manual (updated July 10, 2026)](https://www.medicaid.nv.gov/Downloads/provider/nv_billing_general.pdf)
10. [Nevada Medicaid — Telehealth Billing Instructions (updated 08/03/2026)](https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_Telehealth.pdf)
11. [Nevada Medicaid Services Manual Chapter 3400 — Telehealth Services (effective November 29, 2023)](https://www.nevadamedicaid.nv.gov/uploadedFiles/dhcfpnvgov/content/Resources/AdminSupport/Manuals/MSM/C3400/MSM_3400_23_11_29_ADA.pdf)
12. [Nevada Medicaid Services Manual Chapter 3600 — Managed Care Organization (effective January 1, 2026)](https://www.nevadamedicaid.nv.gov/siteassets/content/resources/adminsupport/manuals/msm/c3600/MSM_3600_26_01-01.pdf)
13. [Nevada Health Authority — Applied Behavior Analysis (ABA) program page](https://www.nevadamedicaid.nv.gov/programs/applied-behavior-analysis-aba/)
14. [Nevada Medicaid — Contact a Health Plan (the five Medicaid health plans, updated 04/08/2026)](https://www.nevadamedicaid.nv.gov/medicaid-members/health-plan-home/contact-a-health-plan/)
15. [Nevada Medicaid — Statewide Managed Care Program (expansion to all counties from January 1, 2026)](https://www.nevadamedicaid.nv.gov/medicaid-members/health-plan-home/statewide-managed-care-program/)
16. [DHCFP letter — Applied Behavioral Analysis Coverage in a PRTF/RTC (June 20, 2024)](https://medicaid.nv.gov/Downloads/provider/web_announcement_3380_20240626.pdf)
17. [Nevada Medicaid Web Announcement 3315 — MSM 3700 changes for SB 191 (ABA regardless of age), March 22, 2024](https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3315_20240322.pdf)
18. [NRS Chapter 422 — NRS 422.27497 (Medicaid ABA services) and 422.2721 (Medicaid telehealth)](https://www.leg.state.nv.us/NRS/NRS-422.html)
19. [NRS Chapter 641D — Applied Behavior Analysis (licensure, endorsement, supervision, prohibited acts)](https://www.leg.state.nv.us/NRS/NRS-641D.html)
20. [NRS 629.031 and 629.515 — Provider of health care defined; Nevada license required for telehealth to a patient in Nevada](https://www.leg.state.nv.us/NRS/NRS-629.html)
21. [BACB — U.S. Licensure of Behavior Analysts (Nevada: NV Applied Behavior Analysis Board)](https://www.bacb.com/u-s-licensure-of-behavior-analysts/)
22. [42 CFR 440.230(e) — State Medicaid agency prior-authorization timeframes (eCFR)](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-440/subpart-B/section-440.230)
23. [42 CFR 433.139 — Medicaid third-party liability (eCFR)](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-433/subpart-D/section-433.139)
24. [Nevada Medicaid — Announcements/Newsletters (web announcements and quarterly provider newsletters)](https://www.medicaid.nv.gov/providers/newsannounce/default)
25. [CareSource Nevada Medicaid — Reimbursement Policy NV MCD-PY-1695, Applied Behavior Analysis for ASD (eff. 01/01/2026)](https://www.caresource.com/documents/medicaid-policy-reimburse-py-1695-20260101.pdf)
26. [CMS — Medicaid NCCI MUE edit file, practitioner services, effective October 1, 2026 (dates of service 10/1–12/31/2026)](https://www.cms.gov/medicare/coding-billing/ncci-medicaid/medicaid-ncci-edit-files)
27. [42 CFR 438.210(d) — Medicaid managed care authorization timeframes (eCFR)](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-438/subpart-D/section-438.210)

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.

Source: Carelu ABA Payer Directory — https://carelu.com/payers. Free to cite with attribution.