This article covers Nevada workers' compensation reimbursement rates for hospital services, emergency services, Ambulatory Surgical Centers (ASCs), and trauma activation fee reimbursement.

Hospital Reimbursement

Emergency Department Reimbursement

Ambulatory Surgical Center (ASC) & Outpatient Surgery

Trauma Activation Fee Reimbursement

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

Hospital Reimbursement

Nevada Specific Codes:

Reimbursement for Observation Care shall be calculated at an hourly rate of $160.09 per hour, or fraction thereof, for stays 23 hours or less.

Diagnostic services, treatment and supplies provided while under hourly Observation Care and are reimbursed in addition to observation care hourly reimbursement for stays 23 hours or less.

Medical supplies are reimbursed at the providers’ actual cost, excluding tax and charges for freight, plus 20%, unless there is a written agreement between the insurer and provider for a lower reimbursement.

Copies of the manufacturers’ or suppliers’ invoices from the provider are required for reimbursement.

Observation stays greater than 23 hours shall be reimbursed at the per diem rate noted above for Nevada Specific Code NV00650 which includes diagnostic services, treatment and supplies. Observation Care rates apply to acute care hospital services only; does not apply to hospital-based outpatient surgical care or ambulatory services. The per diem rate includes all services provided by the hospital including the professional and technical services provided by members of the hospital’s staff and other services ordered by the treating or consulting provider of health care.

Charges for an inpatient’s use of an operating room must be included in the per diem rate for the hospital.

Rural hospitals receive an additional 10% over the established per diem rate.

Hospitals in Clark County, Washoe County, and Carson City are not considered rural hospitals. The insurer shall reimburse the hospital for orthopedic hardware, prosthetic devices, implants and grafts at the provider’s actual cost, excluding tax and charges for freight, plus 20 percent, unless there is a written agreement between the insurer and hospital for a lower reimbursement. Copies of the manufacturers’ or suppliers’ invoices from the provider are required for reimbursement.

The insurer shall reimburse the hospital for supplies and materials, including grafts and implants used in open-heart surgery at the provider’s actual cost, excluding tax and charges for freight, plus 40 percent, unless there is a written agreement between the insurer and hospital for a lower reimbursement.

Copies of the manufacturers’ or suppliers’ invoices from the provider are required for reimbursement.

Emergency Department Reimbursement  

Nevada Specific Codes:

Diagnostic services, treatment and supplies provided by the emergency department are reimbursed in addition to emergency department facility reimbursement.

Medical supplies are reimbursed at the providers’ actual cost, excluding tax and charges for freight, plus 20 percent, unless there is a written agreement between the insurer and provider for a lower reimbursement.

Copies of the manufacturers’ or suppliers’ invoices from the provider are required for reimbursement.

Use of treatment rooms may not be reimbursed separately as reimbursement is included in the hourly reimbursement.

An insurer shall reimburse pharmaceuticals at the average wholesale price or the provider’s usual and customary price, whichever is less, unless there is a written agreement between the insurer and provider for a lower reimbursement.

If an injured employee is admitted to the hospital from the emergency department, charges related to care in the emergency department are reimbursed in addition to the per diem rate(s) for inpatient care received at the hospital.

Ambulatory Surgical Center (ASC) & Outpatient Surgery

Unlisted CPT codes may be reimbursed at Group 8 reimbursement, billed charges, or usual and customary reimbursement in Nevada for comparable procedure codes, whichever is less.

A list of CPT codes and their corresponding groups may be found at the Nevada Workers’ Compensation Section website on the Medical Information page at: http://dir.nv.gov/uploadedFiles/dirnvgov/content/WCS/MedicalDocs/ASCOPGroupList2016.pdf

An insurer shall reimburse an ambulatory surgical center or outpatient hospital surgical service for orthopedic hardware, prosthetic devices, and implants and grafts at the provider’s actual cost, excluding tax and charges for freight, plus 20 percent, unless there is a written agreement between the insurer and provider for a lower reimbursement.

Copies of the manufacturers or suppliers’ invoices from the provider are required for reimbursement.

If there is no assigned value for the surgical procedure, or if the modifier “-51” and or modifier “- 59” are used, or “add-on” procedures are billed, the amount paid shall not exceed the surgical per diem rate for code NV00500, or the amount billed if less than the per diem rate for NV00500.

The following costs are included in ambulatory surgical center and outpatient hospital surgical service reimbursement: all services provided by the ambulatory surgical center or outpatient hospital surgical service, including professional and technical services provided by members of the ambulatory surgical center or outpatient hospital surgical service staff, anesthetic cost, general supplies, operating room, medication and any other diagnostic procedures.

Hospital Reimbursement rates do not apply to hospital-based outpatient surgical care or ambulatory services, except that NV00500 is used as a maximum reimbursement level for outpatient services.

Trauma Activation Fee Reimbursement

Requires notification of trauma team members at designated trauma hospitals in response to triage information received concerning a person who has suffered a traumatic injury as defined by NRS 450B.105.

Trauma activation is based upon parameters set forth in NAC 450B.770 (Procedures for initial identification and care of patients deemed with trauma).

Regardless of the disposition of the patient, all charges related to the appropriate care of the patient above and beyond the activation fee shall apply and are reimbursed per the Nevada Medical Fee Schedule.

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