This article covers Nevada workers' compensation fee schedule sections for providers, including conversion factors, billing rates, and telemedicine requirements.

Fee Schedule Resources

Provider Reimbursement

Surgical Assistants

Chiropractor Assistants

Physical Therapist Assistants & Occupational Therapy Assistants

Telemedicine

Providers can see here for the 2026 Nevada Workers' Compensation Medical Fee Schedule, effective February 1, 2026.

Billing Publications

Pursuant to NRS 616C.260, effective February 1, 2026, providers of health care who treat injured employees pursuant to Chapter 616C of NRS shall use the most recently published editions of, or updates of, the following publications for the billing of workers’ compensation medical treatment:

• Relative Values for Physicians,

Providers of health care shall utilize Nevada Specific Codes for billing when identified in the Nevada Medical Fee Schedule.

Refer to NAC 616C.145 and NAC 616C.146 for information concerning the adoption and purchasing of the Relative Values for Physicians.

These publications are necessary for the billing of medical treatment and payment per the Nevada Medical Fee Schedule and are the providers' and insurers’ responsibility to obtain.

Provider Reimbursement

Provider Service Code Conversion Factor:

Applies to outpatient services provided in physician offices, freestanding facilities and/or hospitals.

Facilities may be reimbursed for the technical portion of an applicable service (as defined in the Relative Values for Physicians) if the service is provided on an outpatient basis.

Services provided in conjunction with procedures and/or surgeries covered under Ambulatory Surgery Centers and Outpatient Hospital Surgical services below are excluded.

If preauthorized by the insurer, licensed physicians, other than anesthesiologists, may receive payment from the Relative Value Guide of the American Society of Anesthesiologists.

Surgical Assistants

Surgical assistant services provided by a licensed registered nurse, a certified physician’s assistant, or an operating room technician employed by a surgeon for surgical assistant services must be identified with the modifier “-29” and be reimbursed at 14 percent of the maximum allowable fee for the surgeon’s services rendered.

Fees for surgical assistant services performed by a licensed registered nurse, a certified physician’s assistant or an operating room technician employed by the hospital or surgical facility must be included in the per diem rate pursuant to NV00500.

Chiropractor Assistants

Services provided by a certified chiropractor’s assistant must be identified with the modifier “-29” and be reimbursed at 40 percent of the maximum allowable fee for chiropractors.

Physical Therapist Assistants & Occupational Therapy Assistants

Services provided by a licensed physical therapist’s assistant or licensed occupational therapy assistant must be identified with the modifier “-29” and be reimbursed at 50 percent of the maximum allowable fee for licensed physical therapists or licensed occupational therapists.

The maximum daily unit value allowed under codes 97001 to 97799 and 98925 to 98943, excluding 97545 and 97546, for those practitioners whose scope of license allows them to perform and bill for these services is 16 units.

The maximum 16-unit value may be exceeded for services provided to an injured employee with trauma to multiple body parts if the insurer, third party administrator, or organization for managed care so authorizes in advance.

Any payment made per this section includes, but is not limited to, payment for the office visit, evaluations and management services, manipulation, modalities, mobilizations, testing and measurements, treatments, procedures, and extra time.

If the services rendered are for physical therapy or occupational therapy and the total unit value of the services provided for 1 day is 16 units or more, the payment of benefit explanation may combine all the services for that day, utilizing code NV97001 as the payment descriptor of services, except for the initial evaluation.

The initial evaluation needs to be identified with the appropriate CPT code. The initial evaluation shall be deemed to be separate from the initial six treatments.

An initial evaluation may be performed on the same day as the initial treatment and must be billed under codes 97161, 97162, 97163 or 97165, 97166, 97167.

The first six visits, billed under codes 97010 to 97799, and 98925 to 98943, excluding 97545 and 97546, do not require the prior authorization of the insurer.

Telemedicine

Nevada Specific Code:

Reimbursement for medical facilities billing an originating site fee for telemedicine services will include all general supplies, technical services, professional services, and costs for the telemedicine transmission.

Diagnostic or other procedures performed in conjunction with a telemedicine visit are separately reimbursable if prior authorized, pursuant to NAC 616C.129.

The consulting health care provider at the distant site must bill using the usual and appropriate CPT code for the service(s) provided.

• Do not use CPT codes specific to telemedicine.
• Always bill telemedicine services with a GT modifier.

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