Written & Reviewed by Akash Biswas, MSW | Former Medicaid Caseworker Trainer | Verified against Medicaid.gov and Nevada DHCFP official guidelines | Last Updated: May 2026
Nevada Medicaid fee schedules for 2026 set the official reimbursement rates that providers receive for covered services.
These rates are managed by the Nevada Health Authority (NVHA) and published by the Division of Nevada Medicaid (formerly DHCFP).
This guide explains how 2026 rates are set, what changed this year, and where to find official fee schedule files.
Quick Summary
- Nevada Medicaid rates are set using a fixed 2014 Medicare conversion factor of $35.8228
- New 2026 CPT and HCPCS codes were fully activated on April 27, 2026
- Behavioral health rates received a 10% increase, plus rural and home-visit add-ons
- Nevada expanded to statewide managed care on January 1, 2026
- A new Single Preferred Drug List (sPDL) took effect January 1, 2026
- Use the Medicaid Eligibility Calculator 2026 to check if you or a patient qualifies
What Is the Nevada Medicaid Fee Schedule?
The Nevada Medicaid fee schedule is a list of approved payment rates for medical services. It tells providers exactly how much Nevada Medicaid will pay for each procedure code.
Fee schedules are published by provider type. They are updated at least once a year — sometimes more often.
Who Manages Nevada Medicaid Rates?
The Nevada Health Authority (NVHA) manages all fee schedule decisions. The Division of Nevada Medicaid (formerly DHCFP) publishes the actual rate files.
Rates are publicly available on the DHCFP rates portal and through the Nevada Medicaid Provider Portal. You can search fee schedules directly at medicaid.nv.gov.
What Law Governs Rate-Setting?
Nevada rate-setting follows Title XIX of the Social Security Act and is reviewed by the Centers for Medicare & Medicaid Services (CMS). Per Assembly Bill 108, NVHA must conduct a full rate review for each provider type at least once every four years. Providers can also appeal rates through the Rate Analysis and Development (RAD) team.
How Nevada Medicaid Calculates 2026 Rates
Nevada uses the standard federal RVU-based formula to calculate fee-for-service (FFS) rates. This formula has three parts: Work RVUs, Practice Expense RVUs, and Malpractice RVUs.
Each part is adjusted by a Geographic Practice Cost Index (GPCI). Nevada’s 2026 GPCIs are: Work = 1.000, PE = 1.000, MP = 0.844.
The Rate Formula
The formula is:
Payment = [(Work RVU × Work GPCI) + (PE RVU × PE GPCI) + (MP RVU × MP GPCI)] × Conversion Factor
Nevada Medicaid uses a fixed 2014 Medicare Conversion Factor of $35.8228. This number does not update automatically each year like Medicare’s does. This is why Nevada Medicaid rates are consistently lower than current Medicare rates.
Facility vs. Non-Facility Rates
Unlike Medicare, Nevada Medicaid does not pay separate rates based on place of service. Each procedure code is assigned either a Facility or Non-Facility rate — not both.
If a code shows a rate of $0.00 on the fee schedule, it is reimbursed at 62% of Usual and Customary charges.
2026 Annual Code Updates
New Codes Activated January 1, 2026
Nevada Medicaid added all new 2026 CPT, HCPCS, and ADA codes to its system effective January 1, 2026. However, many new codes were not yet priced at launch. Claims for those codes suspended under error code 853.
Full Rate Activation: April 27, 2026
Per Web Announcement 3906, all new 2026 codes were fully loaded into the Medicaid Management Information System (MMIS) by April 27, 2026. Claims with dates of service on or after January 1, 2026, that had suspended under error 853 were released for reprocessing.
Quarter 2 2026 Codes
Per Web Announcement 3896, Quarter 2 2026 codes were added to the MMIS on April 20, 2026. These codes are active for dates of service on or after that date.
Nevada Medicaid Rates by Provider Type in 2026
Nevada fee schedules are organized by provider type. Here is a breakdown of major categories and 2026 changes.
Provider Type 20 – Physician (M.D., D.O., Osteopath)
The Provider Type 20 fee schedule was updated in January 2026. The table below shows selected 2025 Medicaid vs. 2025 Medicare rates from the most recent official NVHA comparison report.
| Procedure Code | Description | NV Medicaid Rate | 2025 Medicare Non-Facility | Difference |
|---|---|---|---|---|
| 10060 | I&D abscess, simple | $100.38 | $123.55 | -$23.17 |
| 71045 | Chest X-ray, 1 view | $21.23 | $25.13 | -$3.90 |
| 59400 | Obstetrical care | $2,251.97 | $2,304.71 | -$52.74 |
| 59510 | Cesarean delivery | $2,490.53 | $2,554.44 | -$63.91 |
| 90791 | Psych diagnostic eval | $121.15 | $166.40 | -$45.25 |
| 90837 | Psychotherapy 60 min | $116.09 | $153.89 | -$37.80 |
Source: NVHA February 2026 Report to the Nevada Legislature (NRS 422.2712)
A 2026-to-2026 comparison report had not been published as of May 2026. The February 2026 report uses 2025 Medicare data as its benchmark.
In May 2026, Web Announcement 3910 opened additional procedure codes for billing by Provider Types 20, 24 (APRNs), and 77 (Physician’s Assistants).
Provider Type 19 – Nursing Facility / PT 65 – Hospice
Nursing facility rates are updated quarterly based on acuity and case mix. For State Fiscal Year (SFY) 2026 Quarter 3, updated rates for free-standing nursing facilities took effect on January 1, 2026 (Web Announcement 3831). Prior-period claims were automatically reprocessed at the new Q3 rates.
Hospital-based skilled nursing facilities (SNFs) are paid under Medicare’s cost-based principles, not exceeding the Upper Payment Limit. Free-standing facilities use a facility-specific calculated rate.
Provider Type 13 – Psychiatric Hospital (Inpatient)
Per Web Announcement 3898, CMS approved State Plan Amendment 25-0011, effective April 23, 2026. Private psychiatric hospitals now receive a flat per diem rate of $944. This brings parity with Provider Type 11 (Inpatient Hospital). The rate applies retroactively to claims with dates of service on or after January 1, 2025.
Revenue codes covered include 0114 (R&B-Pvt-Psychiatric), 0116 (Detoxification), 0118 (Rehabilitation), and others.
Provider Type 14 – Behavioral Health Outpatient / PT 26 – Psychologist / PT 82 & 93 – BH Rehab & SUD
Per Web Announcement 3860 and CMS-approved SPA 25-0013, behavioral health codes received significant rate increases effective January 1, 2025:
- 10% base rate increase for psychotherapy and related codes (90791, 90792, 90832–90853, H2014, H2017, and others)
- +10% rural add-on for members with a rural residential address
- +5% home services add-on for services billed with POS Code 12 (Home)
- Members in rural areas receiving home services receive a combined +15% increase
- Peer Support (H0038): Increased to $15 per 15-minute unit; $3 for H0038 with HQ modifier
- Specialized Foster Care (H2019): 10% base increase plus 10% rural add-on
Specific post-increase dollar amounts for 2026 are confirmed accessible only through the Provider Web Portal’s fee schedule search tool.
Provider Type 34 – Therapy (PT, OT, Speech)
Per Web Announcement 3912 (May 5, 2026), a correction was applied to Occupational Therapy (Specialty 28) assessment code rates. The Therapy billing guide was updated effective January 1, 2026. Rates are searchable on the DHCFP fee schedule portal.
Provider Type 33 – Durable Medical Equipment (DMEPOS)
CMS approved State Plan Amendment NV-25-0028, effective March 1, 2026:
- DMEPOS is reimbursed using the 2016 Nevada-specific non-rural fee schedule at 100% of Nevada-specific rates
- If no fee schedule rate exists, reimbursement defaults to the lower of: MSRP minus 25%, acquisition cost plus 20%, or actual billed charge
- Vagus Nerve Stimulation (VNS) Therapy Devices are newly covered at 82% of acquisition cost, including replacement parts
- Custom wheelchair cushions (E2609 and E2617): lower of MSRP minus 20% or acquisition cost plus 20%
Note: Web Announcement 3907 also announced a DMEPOS Federal & Statewide Moratorium for certain DMEPOS providers, effective April 30, 2026.
Provider Type 22 – Dentist
The dental fee schedule reflects rates as of July 2025, with most procedure codes carrying a January 2024 effective date. No 2026-specific dental rate update was confirmed as of May 2026.
| Code | Description | DNI Rate | DEF Rate |
|---|---|---|---|
| D0120 | Periodic Oral Evaluation – Established Patient | $38.39 | $34.90 |
| D0150 | Comprehensive Oral Evaluation | $38.39 | $34.90 |
| D0210 | Intraoral Comprehensive Radiographic Images | $68.07 | $61.89 |
Source: DHCFP Dental Fee Schedule, July 2025
Provider Type 17/174 – FQHC
The FQHC fee schedule (Provider Type 17-174) was updated as of January 2026 and is available from DHCFP.
Nevada Medicaid Fee Schedule 2026 vs. Other States
Nevada’s fee schedule is one of many state-specific Medicaid rate systems. Each state sets its own reimbursement structure.
To compare Nevada’s approach with national averages or other states, see our full guide to the Medicaid Fee Schedule 2026.
State Directed Payments (SDPs) for 2026
CMS approved several State Directed Payments (SDPs) for Nevada Medicaid Managed Care, covering January 1, 2026 through December 31, 2026:
| SDP Category | Total Approved | Federal Share | State Share |
|---|---|---|---|
| Inpatient/Outpatient Hospital (IPH/OPH) | $1,290,268,866 | $967,701,649 | $322,567,216 |
| Academic Medical Center (AMC) Increase | $56,071,432 | $42,552,485 | $13,518,947 |
| CCBHC Quality Payment (Value-Based) | $3,695,095 | $3,033,060 | $662,034 |
Source: CMS State Directed Payment Approvals, Nevada Medicaid 2026
The AMC SDP provides a uniform percentage increase for eligible professional services at academic medical centers. Payments are made quarterly, outside of normal capitation. The goal is to bring AMC provider reimbursement closer to the Average Commercial Rate (ACR).
The CCBHC SDP is designed to increase CCBHC payments from 80% of Medicare to 100% of Medicare. MCO contractors must pay CCBHCs no less than the approved rates in the Medicaid State Plan.
The Hospital SDP applies a uniform percentage increase to inpatient and outpatient hospital services for the full 2026 plan year.
Nevada Statewide Managed Care Expansion (January 1, 2026)
Starting January 1, 2026, Nevada Medicaid expanded to a statewide managed care system. All Nevada counties are now covered — not just Clark and Washoe counties.
Nevada Medicaid now works with five MCOs:
- Health Plan of Nevada (HPN)
- Anthem
- SilverSummit Health Plan
- Molina Healthcare
- CareSource (new, added January 1, 2026)
In rural areas, members can choose from two MCO options: CareSource and SilverSummit. This protects network adequacy in lower-population areas. NVHA estimates a 15% increase in MCO-paid claims due to this rural expansion.
What this means for fee schedules: Most Nevada Medicaid members are now enrolled in managed care. This means MCO contract rates govern most actual provider reimbursements. Fee-for-service rates still apply to FFS claims, but they are no longer the primary payment mechanism for most services.
To understand if your patient or household qualifies for Nevada Medicaid under the new managed care structure, see our guide to Medicaid Eligibility 2026.
2026 Single Preferred Drug List (sPDL)
Effective January 1, 2026, Nevada Medicaid implemented a Single Preferred Drug List (sPDL) across all MCO plans.
Here’s what that means:
- All five MCOs must align their formularies to the sPDL
- Members already on non-preferred drugs have a 6-month transition period through June 30, 2026
- The Silver State Scripts Board (SSSB) manages ongoing PDL updates. Changes took effect February 1, 2026, and again May 1, 2026
- Pharmacy supplies billed using HCPCS/CPT codes are reimbursed at the lower of billed charge or the fixed fee schedule rate
Private Hospital Assessment Rates (SFY 2026)
Per Web Announcement 3785 (December 9, 2025), NVHA revised assessment rates for private hospitals for State Fiscal Year 2026:
- Inpatient services: 7.37619%
- Outpatient services: 6.31309%
These percentages apply to a hospital’s net patient revenue minus Medicare revenue. Hospitals are invoiced by NVHA. Collected assessments generate corresponding supplemental Medicaid payments back to hospitals.
Who Qualifies for Nevada Medicaid in 2026?
Fee schedule rates only apply if a patient is enrolled in Nevada Medicaid. Eligibility is based on income, household size, and category. To see exact income limits for Nevada and all other states, visit our Medicaid Income Limits by State 2026 guide.
Nevada Medicaid covers the following groups:
- Low-income adults (ACA Medicaid expansion)
- Children and pregnant women (via CHIP and Medicaid)
- Seniors and people with disabilities (SSI-linked eligibility)
- Foster care youth up to age 26
Income limits are based on Federal Poverty Level (FPL) and calculated using Modified Adjusted Gross Income (MAGI). Most adults qualify at or below 138% FPL.
How to Apply for Nevada Medicaid in 2026
Applying for Nevada Medicaid is free. Here are your options:
- Apply online at access.nv.gov — Nevada’s official benefits portal
- Apply by phone — Call 1-800-992-0900 (Nevada DWSS)
- Apply in person — Visit your local Division of Welfare and Supportive Services (DWSS) office
- Apply through healthcare.gov — For Medicaid and ACA marketplace options at healthcare.gov/medicaid-chip
- Apply through a Federally Qualified Health Center (FQHC) — Many offer application help on-site
After applying, Nevada Medicaid must make an eligibility determination within 45 days (or 90 days for disability-based cases). Coverage can start the first day of the month you apply, if approved.
Where to Find Nevada Medicaid Fee Schedules in 2026
| Resource | URL |
|---|---|
| DHCFP Rate Analysis & Fee Schedules | dhcfp.nv.gov/Resources/Rates/RATESMAIN |
| Nevada Medicaid Provider Portal | medicaid.nv.gov |
| Provider Billing Guidelines by Type | medicaid.nv.gov/providers/BillingInfo |
| Nevada Medicaid Web Announcements | medicaid.nv.gov/providers/newsannounce |
| NVHA Rate Comparison Reports | nvha.nv.gov |
| CMS State Directed Payment Approvals | medicaid.gov |
Note: Per DHCFP, all fee schedule files are published for informational purposes. Medicaid policy always takes precedence over any listed rate.
Known 2026 Data Gaps (As of May 2026)
Some 2026-specific rate data had not been publicly published as of May 2026:
- 2026 Medicaid vs. 2026 Medicare comparison report — The February 2026 statutory report uses 2025 Medicare benchmarks. A true 2026-to-2026 comparison has not been released.
- Absolute dollar rates for behavioral health codes post-SPA 25-0013 — Only percentage increases were announced. Final dollar amounts require searching the Provider Web Portal directly.
- Updated dental fee schedule (PT 22) — Last dated July 2025 with most rates carrying a January 2024 effective date.
- Facility-specific nursing home rates — Individual per-diem rates are facility-specific and not published in aggregate form.
FAQ: Nevada Medicaid Fee Schedule 2026
Q: What conversion factor does Nevada Medicaid use for physician rates in 2026?
A: Nevada Medicaid uses the fixed 2014 Medicare Physician Fee Schedule Conversion Factor of $35.8228. This amount does not change automatically each year. Because Medicare’s conversion factor has increased since 2014, Nevada Medicaid rates are consistently lower than current Medicare rates for most procedure codes.
Q: When were 2026 CPT codes fully active for Nevada Medicaid billing?
A: New 2026 CPT, HCPCS, and ADA codes were fully loaded and active for billing as of April 27, 2026 (Web Announcement 3906). Claims for these codes that previously suspended under error code 853 were released for retroactive adjudication back to January 1, 2026.
Q: Did behavioral health rates increase in Nevada Medicaid for 2026?
A: Yes. CMS approved a 10% base rate increase for psychotherapy and related behavioral health codes effective January 1, 2025, under SPA 25-0013. An additional 10% rural add-on and a 5% home services add-on also apply. Peer Support (H0038) was increased to $15 per 15-minute unit.
Q: How does Nevada’s managed care expansion affect fee schedules?
A: Since January 1, 2026, all Nevada Medicaid members are enrolled in one of five managed care organizations (MCOs). Most provider payments are now governed by MCO-negotiated contract rates. Fee-for-service rates from the DHCFP schedule apply to FFS claims, but they are no longer the primary payment method for most services.
Q: Where can I find the official Nevada Medicaid fee schedule for my provider type?
A: Visit the DHCFP rates portal at dhcfp.nv.gov/Resources/Rates/RATESMAIN or use the fee schedule search tool at the Nevada Medicaid Provider Portal at medicaid.nv.gov. Fee schedules are organized by provider type and updated annually.
Q: What are the income limits to qualify for Nevada Medicaid in 2026?
A: Most Nevada adults qualify for Medicaid at or below 138% of the Federal Poverty Level (FPL). For a single person, that is approximately $20,783 per year. Income limits vary by household size and eligibility category. Use our Medicaid Eligibility Calculator 2026 to check your exact eligibility in minutes.
Sources & Disclaimer
Sources:
- Nevada Health Authority (NVHA) — February 2026 Rate Comparison Report (NRS 422.2712): nvha.nv.gov
- DHCFP Rate Analysis and Fee Schedules Portal: dhcfp.nv.gov/Resources/Rates/RATESMAIN
- Medicaid.gov — Official U.S. Medicaid Information: medicaid.gov
- Healthcare.gov — Medicaid and CHIP Overview: healthcare.gov/medicaid-chip
- Nevada Medicaid Web Announcements 3788, 3785, 3831, 3860, 3896, 3898, 3906, 3907, 3910, 3912
Disclaimer: CheckMedicaid.com is not affiliated with any government agency. This content is for educational purposes only. Fee schedule rates and policy rules change frequently. For official eligibility and billing information, contact the Nevada Health Authority, visit medicaid.nv.gov, or call 1-800-992-0900.
Last Updated: May 2026
