New PT 93 established to replace PT 17, Specialties 171, and 215, and create new specialties under PT 93

The following is informational only; time frames will be announced when finalized. Please see Nevada Medicaid Web Announcement 3362 for additional information.

The Division of Health Care Financing and Policy (DHCFP) has created provider type (PT) 93 (Substance Use Treatment [SUT]) to improve data collection for and reporting to the Centers for Medicare & Medicaid Services (CMS) as required for DHCFP’s 1115 Demonstration Waiver. Additionally, PT 93 will be structured to require individual enrollment and linkage of alcohol and drug counselors (ADC) and peer recovery support specialists (PRSS) within substance use disorders (SUD) treatment.

The 1115 Demonstration Waiver allows for residential SUD treatment and services to be reimbursed when performed in an Institution for Mental Disease for individuals aged 22 to 64 years old.

Please review the following information regarding provider enrollment, billing, prior authorizations, and training related to this new provider type.

• Providers currently enrolled as PT 17 (Special Clinics) specialty 215 (Substance Use Agency Model (SUAM)) and PT 17 specialty 171 (Methadone) will need to enroll as a PT 93 with Anthem after applying and being approved through the State:
  • Reminder: Providers must have a National Provider Identifier (NPI) to enroll in the new PT 93 specialties.
  • To enroll with Anthem, providers will use Availity Provider Enrollment. Find more information here: https://providers.anthem.com/nevada-provider/join-our-network
• Prior authorization (PA) requirements will remain the same; policy for PAs is not changing. Once enrolled as a PT 93 provider:
  • A new form FA-11D (Substance Use Treatment/Co-Occurring Outpatient Behavioral Health Authorization Request) must be submitted.
  • The provider must request to transfer any remaining units from the PT 17 specialty 215 authorization to the new PT 93 authorization.
• Any transferred PAs to PT 93 will have a new authorization number, which must be included on PT 93 claims, as appropriate.
• Once PT 93 enrollment is active, providers may begin to submit claims under their new PT 93 following the prior authorization and billing requirements.
• When available, these requirements will be found in the new PT 93 Billing Guide on the Billing Information webpage.

Please watch for future web announcements from Nevada Medicaid notifying providers of the date PT 93 will be available for providers to enroll, when the enrollment checklists are available, when providers may start billing under PT 93, and when the billing guide has been posted on the website. Once an organization has completed its enrollment with Nevada Medicaid for PT 93 the organization will need to complete the contracting process with Anthem to be considered participating with Anthem for PT 93. To join the network select: carelonbehavioralhealth.com/providers/join-our-network. If you have questions, contact Carelon Behavioral Health, Inc. directly at provider.inquiry@carelon.com or through their website: carelonbehavioralhealth.com/providers/contact-us.