How the Nevada Workers' Compensation Medical Fee Schedule Works

The schedule is owned by the Workers' Compensation Section (WCS) of the Division of Industrial Relations, which sits inside the Nevada Department of Business and Industry. The DIR Administrator signs each annual edition.

NRS 616C.260(2) requires the Administrator to revise the schedule on or before February 1 each year. The revision is not a fresh rate study. It is a straight inflation adjustment tied to the Bureau of Labor Statistics CPI, Medical Care component.

For 2026, the DIR memo set the adjustment at +2.9%, based on the 2025 annual medical-care CPI. That compares with a 0.27% increase applied the year before. Every 2025 rate was multiplied by 0.029, rounded to the cent, and added back to the 2025 amount.

The current schedule, prior editions, the ASC group list and provider forms are posted on the WCS home page. The date of service, not the date you bill, decides which edition applies.

Nevada prices most professional services by multiplying a relative value from an adopted publication by a Nevada conversion factor. The schedule requires providers to use the most recent editions of these sources:

2026 conversion factors

These dollar amounts apply to outpatient professional services in physician offices, freestanding facilities and hospitals (2026 NMFS, p. 1).

The very different conversion factors reflect how RVP units are scaled within each section, not the relative worth of a specialty. A surgery unit and a medicine unit are not interchangeable.

Services bundled into an ASC or outpatient hospital surgery group payment are excluded from these professional-rate rules for the facility. Facilities may still bill the technical component of a qualifying outpatient service as RVP defines it.

For a professional service, the maximum allowable is the RVP unit value times the Nevada conversion factor for that code's section. The payer then applies modifiers, contracts and the billed amount.

1. Confirm the date of service and open the edition in force on that date.
2. Check for a Nevada Specific Code. If one exists for the service (ED facility time, inpatient day, IME, PPD), bill it at its flat rate and stop.
3. Identify the CPT range to pick the conversion factor.
4. Look up the unit value in the current RVP (or base units in the ASA RVG for anesthesia).
5. Multiply units by the conversion factor.
6. Apply schedule modifiers, such as -29 for non-physician practitioners or -28 for a supervising anesthesiologist.
7. Compare to any written contract and to billed charges. Payers commonly pay the lesser of billed charges, the contract rate or the schedule amount.

Worked examples (illustrative unit values)

RVP and ASA unit values are licensed content, so the units below are hypothetical. The conversion factors and percentages are the real 2026 figures.

Anesthesia time runs in 15-minute units, with any fraction counting as a full unit. The clock starts when the anesthesiologist begins preparing the patient in the operating room and stops when the patient is handed to post-anesthesia care.

Each provider type follows its own payment method under the 2026 schedule. All figures below are from the 2026 NMFS.

Non-physician practitioners and assistants

Surgical assistants employed by the hospital or surgery center are not billed separately. Their cost is built into the NV00500 per diem.

Physical therapy, occupational therapy and chiropractic

Codes 97001–97799 and 98925–98943 (excluding 97545 and 97546) are capped at 16 units per day. The insurer, TPA or MCO can authorize more in advance for trauma to multiple body parts. The cap covers the office visit, E/M, manipulation, modalities, testing and extra time.

The first six visits need no prior authorization. The initial evaluation (97161–97163 for PT, 97165–97167 for OT) is separate from those six visits and may happen the same day as the first treatment. When a day reaches 16 units, the payer may roll the day into NV97001 on the EOB.

Hospital inpatient and emergency department

Inpatient care is paid per day by unit type, not by DRG. The per diem includes all hospital services, staff professional services and the operating room.

Rural hospitals get 10% above the per diem. Hospitals in Clark County, Washoe County and Carson City are not rural. ED diagnostics, treatment and supplies are paid on top of the ED hourly rate, and ED charges are paid in addition to inpatient per diems when the patient is admitted.

Ambulatory surgery centers and outpatient hospital surgery

Facility fees follow nine payment groups from the 2016 group list. The rate covers staff, anesthetic cost, general supplies, the OR, medication and diagnostics.

An unlisted CPT code pays the least of Group 8, billed charges, or Nevada usual and customary for a comparable code. When a procedure has no assigned group, or carries modifier -51 or -59, or is an add-on, payment cannot exceed the NV00500 per diem.

Implants, supplies, DME and orthotics

Pharmacy

Outpatient drugs pay the lesser of average wholesale price (AWP) plus a $13.70 dispensing fee, or the provider's usual and customary price. Compounds need prior authorization and must be billed ingredient by ingredient with a valid NDC for each. Physician-dispensed controlled substances are governed separately by NRS 616C.117. DIR's site also lists the ODG Drug Formulary adoption under SB 317 (2025), which pharmacy billers should review alongside the schedule.

Telemedicine, home health and dental

The originating site bills NV00250 at $274.09. The distant-site provider bills the normal CPT code with a GT modifier and must not use telemedicine-specific CPT codes.

Home health is paid per visit up to 2 hours: NV90170 skilled care at $152.83 and NV90130 CNA care at $74.47. Longer visits pay hourly: NV90180 at $76.39 and NV90190 at $37.24. One 24-hour period cannot exceed the NV00500 per diem.

The schedule lists flat rates for 27 dental codes, such as D7140 simple extraction at $128.84 and D6010 implant placement at $1,830.16. Unlisted dental codes pay usual and customary unless a contract says otherwise.

Nevada Specific Codes carry flat rates and must be used whenever the schedule lists one; billing the CPT equivalent instead is a common denial reason. Beyond the hospital and home health codes above, NSCs cover the evaluations that drive claim decisions.

A no-show code (NV02000, NV01001, NV99061) may be billed only when the injured employee is more than 30 minutes late or cancels less than 24 hours ahead. Records sent to an evaluator must be printable, in date-of-service order, and carry a cover sheet stating the page count.

What counts as one body part

For IME and PPD pricing, each of these is one body part: cervical spine, thoracic spine, lumbar spine, pelvis, left upper extremity (excluding hand), right upper extremity (excluding hand), left hand, right hand, left lower extremity, right lower extremity, head, trunk, and PTSD impairment under NRS 616C.180. Counting these correctly is what decides whether NV02003 or NV01004 add-on charges are payable.

Nevada gives providers 90 days to bill and payers 45 days to pay or deny, and almost every other rule hangs off those two clocks. The table lists the deadlines from the 2026 NMFS and DIR's 2026 medical billing training.

Claim form and coding

• Bill professional services on the current CMS-1500 (formerly HCFA-1500), per NAC 616A.480.
• Code with CPT, HCPCS, ICD-10-CM and Nevada Specific Codes. Revenue codes alone are not payable.
• Use the schedule's own modifiers (-29, -28, GT) plus RVP modifiers such as -26 and -TC.
• Nevada has adopted no bundling edits. NCCI or similar edits apply only if a contract says so.

Prior authorization

Under NAC 616C.129, written prior authorization is required for elective surgeries, procedures and hospitalizations, consultations and diagnostic tests estimated at $200 or more. Without it, the insurer is not liable except in a documented emergency. A valid authorization is in writing and names the provider, service, date of service, location, authorizer and date approved.

Treatment by an out-of-state provider needs written prior authorization stating that payment will follow the Nevada schedule (NAC 616C.143). Without that, the insurer alone is responsible for whatever is billed.

Balance billing

Under NRS 616C.135, a provider may not bill the injured employee. The exceptions are a denied claim or services unrelated to the industrial injury, and the provider must hold a copy of the written denial first. Because compensability denials are often overturned on appeal, many billers hold the account rather than bill the patient right away.

The fee schedule is a ceiling, not a floor. A written contract between the provider and the insurer, MCO or PPO network can set a lower rate, and almost every supply, drug and implant rule in the schedule says so explicitly. Payment is generally the lesser of billed charges and the schedule value (Medata NV FAQ), and the lesser of that and any contract rate. WCS will not rule on contract terms, such as a PPO discount or a network's use of CCI edits.

What the payer may and may not do

• The EOB must show, for every code, the amount paid, reduced or disallowed, the reason, and the provider's right to seek WCS review within 60 days.
• When some codes are wrong, the payer must pay the correctly coded lines, return the rest with a specific request, and decide within 20 days of resubmission.
• Downcoding is not allowed. A payer may not pay a lower-level code than the one billed; it must deny or ask for documentation instead.
• Insurers and TPAs may not push providers off to their bill-review vendors. WCS fines land on the insurer or TPA, not its contractor.

How to escalate a reduction or denial

1. Contact the payer in writing (email or letter). DIR says phone messages alone do not count as an attempt to resolve.
2. Keep a dated log of each follow-up.
3. If unresolved, file with the WCS Medical Unit within 60 days of the EOB or explanation of review, or of the date payment was due.
4. Include a written explanation of the dispute, copies of all bills, relevant medical records, the prior authorization, the EOB or EOR, and proof of your efforts with the payer.

WCS Medical Unit contacts: Las Vegas (702) 486-9080, Carson City (775) 684-7270, medunit@dir.nv.gov.

Most Nevada workers' comp denials trace back to a handful of avoidable errors that DIR itself flags in its 2026 billing training.

Checklist before every claim

• Date of service matched to the right NMFS edition
• Written prior authorization on file for items of $200 or more
• Nevada Specific Code used where one exists
• Current RVP and ASA RVG editions used for unit values
• Schedule modifiers applied (-29, -28, GT) and RVP modifiers where relevant
• PT/OT/chiro daily units at or under 16, or extra units pre-authorized
• Invoices attached for implants, hardware, DME and supplies
• Compound drugs billed per ingredient with valid NDCs
• Report sent within 14 days and claim filed within 90 days
• Patient not billed without a written claim denial

Nevada's schedule rewards practices that bill by its own logic: the right edition for the date of service, a Nevada Specific Code wherever one exists, current RVP and ASA units, the schedule's modifiers, and invoices for every cost-plus item. Miss any of those and the payer can lawfully reduce or deny, and the 60-day appeal window closes fast.

If your team is spending hours reworking Nevada workers' comp EOBs, chasing prior authorizations or tracking 90-day and 12-month deadlines by hand, a specialist billing partner can recover that revenue. Talk to our workers' compensation billing team about a free review of your Nevada claims.

• 2026 Nevada Medical Fee Schedule and CPI memo, DIR WCS
• Medical Billing training deck, DIR WCS, 2026
• DIR Workers' Compensation Section home page
• ASC Hospital Outpatient Group List 2016
• BLS CPI, Medical Care (CUUR0000SAM)
• Nevada Workers' Compensation Fee Schedule FAQ, Medata