Nevada Medical Lien Law for Outpatient Providers (2026)

Nevada's lien statute covers hospitals. Chiropractors, physical therapists, physicians, imaging centers and surgery centers treating injury patients rely on signed lien agreements and letters of protection from the patient's attorney. The State Bar of Nevada treats those as interests the attorney must honor once the attorney knows about them, but attorney fee liens come first.

At a glance

Question	Answer
Statutory lien for outpatient providers	Hospitals only (NRS 108.590). The State Bar of Nevada describes the general medical lien as contractual or equitable, not statutory.
Main law	NRS 108.585 to 108.660 (hospital liens)
What outpatient providers usually rely on	Lien agreements with the patient and letters of protection (LOPs) from the patient's attorney
Notice or filing	Hospitals: record with the county recorder and serve the liable party and its insurer by certified mail. No statutory filing step for contract liens or LOPs.
Limits on the amount	Hospital liens: reasonable value, no lien on attorney fees and costs, no lien for care after settlement. Attorney fee liens outrank medical liens (Michel).
Health insurance and billing the patient	Hospitals must bill the patient's health insurance or public program before other collection (NRS 449A.159). Providers may not buy another provider's lien on the same claim (NRS 629.078).
Billed vs. paid in the case	Evidence of a medical lien is admissible to show provider bias, but what a buyer paid for the lien is not (Khoury). In malpractice cases, insurance write-downs are inadmissible (Taylor v. Brill).
Recent changes (2023–2026)	Taylor v. Brill (2023): write-downs inadmissible under NRS 42.021 in malpractice cases, and bills can be shown reasonable without expert testimony.

Is there a lien law for outpatient providers?

Nevada's statute gives a lien to hospitals. When a person "receives hospitalization on account of any injury" and claims damages from the person responsible, "the hospital has a lien" on any judgment, settlement or compromise, for "the reasonable value of the hospitalization rendered before the date of judgment, settlement or compromise" (NRS 108.590(1)). The lien does not apply to anyone covered by Nevada's workers' compensation chapters (NRS 108.590(2)).

The State Bar of Nevada describes the general "medical lien" as "not a statutory lien" but "a type of contractual or equitable lien," and notes that "Nevada has created a hospital lien by statute" (Formal Opinion 31).

A separate statute, NRS 108.662, gives county and district hospitals a lien on a patient's real property for unpaid charges. It is not a lien on an injury recovery.

Notice and filing

Lien agreements and letters of protection have no statutory filing step. The recording rules apply only to hospitals, but they show how the hospital lien works alongside an outpatient provider's claim. To perfect its lien, a hospital must (NRS 108.610):

record a notice of lien with an itemized statement before any payment to the injured person, with the county recorder where the hospital is located and, if different, where the injury happened;
serve a certified copy by registered or certified mail on the person alleged to be responsible, before judgment, settlement or compromise; and
serve the same way on that person's liability insurer, if known.

A hospital that contracts with the patient's health insurer must also send a notice of intent to file a lien within 90 days after hospitalization ends, then bill the health insurer under NRS 449A.159 within 30 days. If it does not, the notice is "void ab initio" (NRS 108.605). This does not apply to Medicaid, Medicare or CHIP.

A person or insurer who pays the injured person or their attorney after getting the certified notice, without paying the hospital, is liable to the hospital for 180 days after that payment (NRS 108.650).

Limits on what the provider is paid

Hospital liens are limited to "reasonable value." A hospital has no lien for care provided after a settlement, and no lien "against any sum incurred by the injured party for necessary attorney fees, costs and expenses" of getting the recovery (NRS 108.600).

For outpatient providers, the bigger issue is priority. In Michel v. Eighth Judicial District Court (2001), the Nevada Supreme Court held that attorney liens have priority over medical provider liens and are not shared pro rata. The court read NRS 108.600(2) as reflecting "the general policy that attorney liens take priority over those of medical service providers." The medical liens in that case belonged to a chiropractic clinic and an imaging center. Attorney liens arise under NRS 18.015.

Lien agreements and letters of protection

The State Bar treats two arrangements as creating an "interest" in the settlement funds that the patient's attorney must honor (Formal Opinion 31):

a medical lien, meaning an oral or written promise to pay the provider from the injury recovery; and
a letter of protection, where the attorney promises payment from the recovery to induce treatment.

The State Bar's Formal Opinion 53 (2017) describes medical liens as "contracts between the client, physician or other care provider, and the attorney" that promise payment from any recovery. The provider holds off on collection until the case ends.

Nevada restricts lien buying:

Providers. A provider or health facility, or a business it has a financial interest in, may not buy or acquire a debt or lien for services that another provider gave the same patient on the same claim. Violations are a category E felony, with fines up to $25,000 per violation (NRS 629.078).
Injury lawyers. Formal Opinion 53 says it is unethical for personal injury attorneys to be in the business of buying and selling medical liens on other attorneys' clients.

The attorney's duty to pay the provider

Under Formal Opinion 31, once a provider has an interest in the funds (an LOP, a medical lien or a statutory hospital lien) and the lawyer actually knows of it, the lawyer must promptly notify the provider when funds arrive, promptly deliver what the provider is entitled to, and account on request. The current rule is NRPC 1.15.

The lawyer may have these duties "even though the client has instructed the lawyer to the contrary."
If the client disputes the provider's claim, the lawyer keeps the disputed portion separate until it is resolved, and may interplead the funds under NRCP 22.
A lawyer who pays out funds in breach of an LOP may be personally liable for conversion.
The lawyer has no duty to search for unknown claimants. Knowing that the client simply owes a bill, with no promise to pay from the recovery, does not create an interest.
When negotiating reductions, NRPC 1.15(d) requires that lienholders be given an accounting (Formal Opinion 53).

Opinion 31 was written under former SCR 165 and reissued in 2015. State Bar ethics opinions are advisory.

Health insurance, no-fault and billing the patient

A Nevada hospital may not pursue collection, other than copays and deductibles, from a patient who has health insurance or may be eligible for Medicaid, CHIP or another public program until it has billed that payer and received a determination (NRS 449A.159(1)). Hospitals contracted with the patient's insurer must follow this to keep their lien rights (NRS 108.605).

Formal Opinion 53 describes lien providers as accepting "a risk that no payment will ever be received," but that describes practice, not a legal rule. We could not confirm in a primary source a Nevada rule on whether a non-hospital provider can bill the patient after a lost case or a short recovery.

Billed vs. paid medical damages

Collateral source rule. Nevada bars evidence of payments from a collateral source, such as insurance benefits, for any purpose (Proctor v. Castelletti, 112 Nev. 88 (1996)).
Lien evidence. In Khoury v. Seastrand (2016), the Nevada Supreme Court held that "evidence of the existence of medical liens to prove bias does not invoke the collateral source rule." It warned that the defense cannot use this as a "backdoor" to ask whether the provider would write the lien down if the plaintiff loses. What a third-party buyer paid for the lien is irrelevant to the reasonable value of the care.
Liability insurer payments. A payment from the defendant's own liability insurer is not a collateral source and is offset (Padilla v. Hunt, 2018).
Medical malpractice. Under NRS 42.021(1), insurance write-downs are inadmissible because they are not benefits paid to the plaintiff. The court also held that expert testimony is not required to prove bills reasonable when other evidence does (Taylor v. Brill, 2023).

Recent changes

Taylor v. Brill (December 2023) held that in malpractice cases, write-downs are inadmissible and lay testimony can establish that bills are reasonable. Expert testimony is no longer a blanket requirement.

What this means for your practice

Your protection is in writing. Without a statutory lien, a signed lien agreement with the patient and an LOP from the patient's attorney that promises payment from the recovery are what create an interest in the settlement.
Make sure the attorney knows. The ethics duty to hold and pay your share attaches only to interests the lawyer actually knows about. A plain unpaid bill does not count.
Expect attorney fees to come off the top. Attorney liens outrank medical liens (Michel), so any reduction comes from what remains after fees and costs.
Your lien can come up at trial. The defense may raise your lien to suggest bias (Khoury), so keep records showing your charges and the medical need for the care.
Do not buy other providers' liens on the same claim. NRS 629.078 makes that a felony for a provider or a business it has an interest in.

Sources

How we verified: the NRS hospital lien text, including NRS 108.590 and 108.662, was checked against the 2025 Nevada Revised Statutes on Justia; other NRS sections were read through a public mirror of the official code.