Last updated 06/17/2024
Definitions
Behavioral Health
Telemedicine – the use of electronic information, imaging and communication technologies, including interactive audio, video, data communications as well asstore and forward technologies, to provide and support health care delivery, diagnosis, consultation, treatment, transfer of medical data and education when distance separates the patient and the health care provider (NMSA, 1978, Section 24-25-3. C).
Forwarding an image or information to a different provider for interpretation is not considered store-and-forward technology eligible for reimbursement unless it is to obtain information necessary for treating the recipient during the telemedicine session.
Telehealth services – An interactive HIPAA compliant telecommunication system must include both interactive audio and video and be delivered on a real-time basis at both the originating and distant sites, as in subsection M of 8.310.2 NMAC.
The terms telehealth and telemedicine are used interchangeably in the Medicaid program. To qualify as a billable telemedicine service, the system must meet all federal requirements for interactivity using a secure connection and meet HIPAA standards for privacy and security.
It is important to note that during this COVID-19 pandemic the federal government has announced that it will not impose penalties for noncompliance with HIPAA rules related to good faith provision of telehealth (such as use of non-HIPAA compliant platforms like Skype or Facetime). For more details about platforms acceptable to the federal government at this time see the U.S. Department of Health and Human Services website: https://www.hhs.gov/hipaa/forprofessionals/special-topics/emergency-preparedness/notification-enforcement-discretiontelehealth/index.html
Note: The COVID-19 pandemic enforcement discretion allowance referenced above has ended. HIPAA requirements around privacy and security are again in full force.
SOURCE: NM Human Services Dept. Behavioral Health Policy and Billing Manual for Providers Treating Medicaid Beneficiaries (2021) p. 27 (Accessed Jun. 2024).
Last updated 06/17/2024
Email, Phone & Fax
MAD will reimburse eligible providers for limited professional services delivered by telephone without video. No additional reimbursement is made to the originating-site for an interactive telemedicine system fee.
SOURCE: NM Administrative Code 8.310.2.12 M(2). (Accessed Jun. 2024).
MAD covers service plan updates through the participation of interdisciplinary teams.
The six elements of teaming may be performed by using a variety of media (with the person’s knowledge and consent) e.g., texting members to update them on an emergent event; using email communications to ask or answer questions; sharing assessments, plans and reports; conducting conference calls via telephone; using telehealth platforms conferences; and, conducting face-to-face meetings with the person present when key decisions are made. Only the last element, that is, conducting the final face-to-face meeting with the recipient present when key decisions that result in the updates to the service plan, is a billable event.
SOURCE: NM Administrative Code 8.321.2.9 (L)(3c). (Accessed Jun. 2024).
Multi Systemic Therapy: Weekly supervision must also include one hour of local group supervision and one hour of telephone consultation per week with the MST systems supervisor.
Crisis Stabilization: Services include telephone crisis services; face-to-face crisis intervention in a clinic setting; and outpatient crisis stabilization services.
Community-based Mobile Crisis Intervention Services: Services may also include telephonic follow-up interventions for up to 72 hours after the initial mobile response.
SOURCE: State Plan Amendment, Supplement A to Attachment 3.1A, (Accessed Jun. 2024).
Last updated 06/17/2024
Live Video
POLICY
Reimbursement for professional services at the originating-site and the distant-site are made at the same rate as when the services provided are furnished without the use of a telecommunication system.
SOURCE: NM Administrative Code 8.310.2.12(M)(d). (Accessed Jun. 2024).
New Mexico Medicaid will reimburse the originating site for services provided under telemedicine at the same rate as when the services are furnished without the use of a telecommunication system.
SOURCE: NM Human Services Dept. Behavioral Health Policy and Billing Manual for Providers Treating Medicaid Beneficiaries (2021) p. 30 (Accessed Jun. 2024).
Telemedicine is also covered by NM Managed Care.
SOURCE: NM Medical Assistance Division Managed Care Policy Manual, p. 323. Oct. 1, 2020. (Accessed Jun. 2024).
Effective October 1, 2022, New Mexico is updating its State Plan to clarify that telehealth and teleconsultation services are reimbursed at the same rate as face-to-face.
SOURCE: New Mexico State Plan Amendment, NM-22-0021, (Dec. 2022), (Accessed Jun. 2024).
Managed Care Program
The benefit package includes telemedicine services as detailed in 8.310.2 NMAC.
SOURCE: NM Admin Code Sec. 8.309.4.16 (Accessed Jun. 2024).
The benefit package includes telemedicine services as detailed in 8.310.2 NMAC. The MCO must:
- promote and employ broad-based utilization of statewide access to Health Insurance Portability and Accountability Act (HIPAA)-compliant telemedicine service systems including, but not limited to, access to text telephones or teletype (TTYs) and 711 telecommunication relay services;
- follow state guidelines for telemedicine equipment or connectivity;
- follow accepted HIPAA and 42 CFR part two regulations that affect telemedicine transmission, including but not limited to staff and contract provider training, room setup, security of transmission lines, etc; the MCO shall have and implement policies and procedures that follow all federal and state security and procedure guidelines;
- identify, develop, and implement training for accepted telemedicine practices;
- participate in the needs assessment of the organizational, developmental, and programmatic requirements of telemedicine programs;
- report to HSD on the telemedicine outcomes of telemedicine projects and submit the telemedicine report; and
- ensure that telemedicine services meet the following shared values, which are ensuring: competent care with regard to culture and language needs; work sites are distributed across the state, including native American sites for both clinical and educational purposes; and coordination of telemedicine and technical functions at either end of network connection.
SOURCE: NM Admin Code 8.308.9.18. (Accessed Jun. 2024).
Provision of telemedicine services does not require that a certified medicaid healthcare provider be physically present with the MAP eligible recipient at the originating site unless the telemedicine consultant at the distant site deems it necessary.
SOURCE: NM Administrative Code 8.310.2.12 (M). (Accessed Jun. 2024).
The MCO is encouraged to use technology, such as telemedicine, to ensure access and availability of services statewide.
SOURCE: NM Administrative Code 8.308.2.12 (Q). (Accessed Jun. 2024).
The alternative benefits package includes telemedicine services.
SOURCE: NM Centennial Care Managed Care Policy Manual, Oct. 1. 2020, (Accessed Jun. 2024).
ELIGIBLE SERVICES/SPECIALTIES
A service provided through telemedicine is subject to the same program restrictions, limitations and coverage which exist for the service when not provided through telemedicine. Telemedicine services are not covered when audio/video technology is used in furnishing a service when the MAP eligible recipient and the practitioner are in the same institutional or office setting.
SOURCE: NM Administrative Code 8.310.2.12 M(4). (Accessed Jun. 2024).
MAD covers service plan updates through the participation of interdisciplinary teams.
The six elements of teaming may be performed by using a variety of media (with the person’s knowledge and consent) e.g., texting members to update them on an emergent event; using email communications to ask or answer questions; sharing assessments, plans and reports; conducting conference calls via telephone; using telehealth platforms conferences; and, conducting face-to-face meetings with the person present when key decisions are made. Only the last element, that is, conducting the final face-to-face meeting with the recipient present when key decisions that result in the updates to the service plan, is a billable event.
SOURCE: NM Administrative Code 8.321.2.9 (L) & (L)(3c). (Accessed Jun. 2024).
Medication Assisted Treatment for Buprenorphine (MAT) services are reimbursable with telemedicine.
See manual for additional requirements, including online prescribing requirements.
SOURCE: NM Behavioral Health Policy and Billing Manual for Providers, 2021, (Accessed Jun. 2024).
School-Based Services
Telemedicine services provided in accordance with 8.210.2 NMAC [section may be referencing 8.310.2 NMAC instead]. The modifier “GT” should be utilized when billing for services provided via telemedicine.
SOURCE: NM Medicaid Guide for School-Based Services, Revised Aug. 2023 pg. 19. (Accessed Jun. 2024).
Medication-Assisted Abortion Services
HSD is adding an option for providing this medical service via telehealth. This service will also be reimbursed at a global rate. The code S0199 with the 95 Modifier will be opened to allow for the telehealth visits for medication-assisted abortion services that include the telehealth visits with counseling. Ancillary services related to the medication assisted abortion are included in the global reimbursement and should not be billed separately. However, services unrelated to the surgical abortion, but provided in the same visit, should be billed separately. For example, if the member receives contraceptive services, vaccines, or behavioral health services those shall be reimbursed separately from the global rate below.
SOURCE: NM Medical Assistance Program Manual, Supplement, Changes to Claim Submittal Process and Rates for Abortion Procedures, Aug. 21, 2023, Number 23-07, (Accessed Jun. 2024).
Crisis Services
Crisis Triage Centers: The following individuals and practitioners must be contracted or employed by the provider agency as part of its crisis triage center service delivery:…
- a charge nurse on duty 24 hours/day, seven days/week this requirement may be met by a through access to a supervising nurse who is available via telehealth.
Community-based Mobile Crisis Intervention Services: All Mobile Crisis Intervention and Mobile Responsive and Stabilization Services must be under the supervision of an independently licensed behavioral health professional who must be available to provide real time clinical assessment in person or via telehealth.
Therapeutic Interventions: Services provided by licensed behavioral health practitioners via telehealth technologies are covered subject to the limitations as set forth in state regulations.
SOURCE: State Plan Amendment, Supplement A to Attachment 3.1A, (Accessed Jun. 2024).
Mobile crisis services are furnished by a multidisciplinary mobile crisis team (MCT) that includes at least two members. The team includes at least one behavioral health care professional able to conduct a mobile crisis screening and assessment within their permitted scope of practice under state law and who may be available via telehealth.
SOURCE: NM Medical Assistance Program Manual, Supplement, Implementation of Mobile Crisis Intervention Services and Mobile Response and Stabilization, Mar. 18, 2024, Number 24-03, (Accessed Jun. 2024).
ELIGIBLE PROVIDERS
Reimbursement for professional services at the originating-site and the distant-site are made at the same rate as when the services provided are furnished without the use of a telecommunication system. In addition, reimbursement is made to the originating-site for a real-time interactive audio/video technology telemedicine system fee (where the MAP eligible recipient is located, if another eligible provider accompanies the patient) at the lesser of the provider’s billed charge, or the maximum allowed by MAD for the specific service of procedure. If the originating site is the patient’s home, the originating site fee should not be billed if the eligible provider does not accompany the MAP eligible recipient. The MAP eligible recipient is not reimbursed for their computer/internet.
SOURCE: NM Administrative Code 8.310.2.12 (M)(d). (Accessed Jun. 2024).
Reimbursement for services at the originating-site (where the MAP eligible recipient is located) and the distant-site (where the provider is located) are made at the same amount as when the services provided are furnished without the use of a telecommunication system. In addition, reimbursement is made to the originating-site for an interactive telemedicine system fee at the lesser of the provider’s billed charge; or the maximum allowed by MAD for the specific service or procedure.
SOURCE: NM Administrative Code 8.310.3.11. (Accessed Jun. 2024).
Behavioral Health
Distant site – The location where the telemedicine provider is physically located at the time of the telemedicine service. See subsection M of 8.310.2.
SOURCE: NM Human Services Dept. Behavioral Health Policy and Billing Manual for Providers Treating Medicaid Beneficiaries (2021) p. 27 (Accessed Jun. 2024).
Mobile Response
Children’s Mobile Response and Stabilization Services (MRSS) teams include at least one behavioral health care professional able to conduct a mobile crisis screening and assessment within their permitted scope of practice under state law, who may be available via telehealth.
SOURCE: NM Medical Assistance Program Manual, Supplement, Implementation of Mobile Crisis Intervention Services and Mobile Response and Stabilization, Mar. 18, 2024, Number 24-03, (Accessed Jun. 2024).
Community Health Worker
A CHW service provided in accordance with NMAC 8.310.2.12.M may be billed using one of the following modifiers:
- GT: Interactive telecommunication; or
- 95: Synchronous Telemedicine Service Rendered via Real-Time Interactive Audio and Video Telecommunications System.
SOURCE: NM Medical Assistance Program Supplement, Number 24-08, May 31, 2024, (Accessed Jun. 2024).
ELIGIBLE SITES
For telemedicine services, when the originating-site is in New Mexico and the distant-site is outside New Mexico, the provider at the distant-site must be licensed for telemedicine to the extent required by New Mexico state law and NMAC rules or meet federal requirements for providing services to IHS facilities or tribal contract facilities.
SOURCE: NM Administrative Code 8.310.3.9 (F). (Accessed Jun. 2024).
An interactive HIPAA compliant telecommunication system must include both interactive audio and video and be delivered on a real-time basis at the originating and distant sites. If real-time audio/video technology is used in furnishing a service when the MAP eligible recipient and the practitioner are in the same institutional or office setting, then the practitioner should bill for the service furnished as if it was furnished in person as a face to face encounter. Coverage for services rendered through telemedicine shall be determined in a manner consistent with medicaid coverage for health care services provided through in person consultation. For telemedicine services, when the originating-site is in New Mexico and the distant-site is outside New Mexico, the provider at the distant-site must be licensed for telemedicine to the extent required by New Mexico state law and regulations or meet federal requirements for providing services to IHS facilities or tribal contract facilities. Provision of telemedicine services does not require that a certified medicaid healthcare provider be physically present with the MAP eligible recipient at the originating site unless the telemedicine consultant at the distant site deems it necessary.
SOURCE: NM Administrative Code 8.310.2.12 (M). (Accessed Jun. 2024).
School-based services provided via telemedicine are covered.
SOURCE: NM Administrative Code 8.320.6.13(I). (Accessed Jun. 2024).
Telemedicine originating-site
The location of a MAP eligible recipient at the time the service is being furnished via an interactive telemedicine communications system. The origination-site can be any of the following medically warranted sites where services are furnished to a MAP eligible recipient.
- The office of a physician or practitioner.
- A critical access hospital (as described in section 1861 (mm)(1) of the Act).
- A rural health clinic (as described in 1861 (mm)(2) of the Act).
- A federally qualified health center (as defined in section 1861 (aa)(4) of the Act).
- A hospital (as defined in section 1861 (e) of the Act).
- A hospital-based or critical access hospital-based renal dialysis center (including satellites).
- A skilled nursing facility (as defined in section 1819(a) of the Act).
- A community mental health center (as defined in section 1861(ff)(3)(B) of the Act).
- A renal dialysis facility (only for the purposes of the home dialysis monthly ESRD-related clinical assessment in section 1881(b)(3)(B) of the Act).
- The home of an individual (only for purposes of the home dialysis ESRD-related clinical assessment in section 1881(b)(3)(B) of the Act).
- A mobile stroke unit (only for the purposes of diagnosis, evaluation, or treatment of symptoms of an acute stroke provided in accordance with section 1834(m)(6) of the Act).
- The home of an individual (only for the purposes of treatment of a substance use disorder or a co-occurring mental health disorder), furnished on or after July 1, 2019, to an individual with a substance use disorder diagnosis.
- The home of an individual when an interactive audio and video telecommunication system that permits real-time visit is used between the eligible provider and the MAP eligible recipient.
- A School Based Health Center (SBHC) as defined by section 2110(c)(9) of the Act.
SOURCE: NM Administrative Code 8.310.2.12 (M)(a). (Accessed Jun. 2024).
Telemedicine distant-site
The location where the telemedicine provider is physically located at the time of the telemedicine service. All services are covered to the same extent the service and the provider are covered when not provided through telemedicine. For these services, use of the telemedicine communications system fulfills the requirement for a face-to-face encounter.
SOURCE: NM Administrative Code 8.310.2.12 (M)(b). (Accessed Jun. 2024).
Behavioral Health
Originating site -The location of an eligible Medicaid recipient at the time the service is furnished via an interactive telecommunications system. See subsection M of 8.310.2.
Importantly, a health coverage plan may not impose originating-site restriction (e.g., home) with respect to telemedicine services. There should be no distinguishing between provided telemedicine services to patients in rural locations or those in urban locations, (NMSA, 1978, Section 13-7-14. B).
SOURCE: NM Human Services Dept. Behavioral Health Policy and Billing Manual for Providers Treating Medicaid Beneficiaries (2021) p. 27 (Accessed Jun. 2024).
GEOGRAPHIC LIMITS
No Reference Found
FACILITY/TRANSMISSION FEE
Reimbursement is made to the originating-site for a real-time interactive audio/video technology telemedicine system fee (where the MAP eligible recipient is located, if another eligible provider accompanies the patient) at the lesser of the provider’s billed charge, or the maximum allowed by MAD for the specific service of procedure. If the originating site is the patient’s home, the originating site fee should not be billed if the eligible provider does not accompany the MAP eligible recipient. The MAP eligible recipient is not reimbursed for their computer/internet.
A telemedicine originating-site communication system fee is covered if the MAP eligible recipient was present at and participated in the telemedicine visit at the originating-site and the system that is used meets the definition of a telemedicine system.
SOURCE: NM Administrative Code 8.310.2.12 M(d). (Accessed Jun. 2024).
Indian Health Services
Originating Site Fee:
A telemedicine originating site fee is covered when the requirements of 8.310.2 NMAC are met;
- Both the originating and distant sites may be IHS or tribal facilities at two different locations or if the distant site is under contract to the IHS or tribal facility and would qualify to be an enrolled provider;
- A telemedicine originating site fee is not payable if the telemedicine technology is used to connect an employee or staff member of a facility to the eligible recipient being seen at the same facility;
However, even if the service does not qualify for a telemedicine originating site fee, the use of telemedicine technology may be appropriate thereby allowing the service provided to meet the standards to qualify as an encounter by providing the equivalent of face-to-face contact.
SOURCE: NM Administrative Code 8.310.12.12. (8) (Accessed Jun. 2024).
Indian Health Services and Tribal 638s
A telemedicine communication fee is paid for the originating site at fee schedule rates using the CMS 1500 format; not the OMB rate.
The originating clinical service fee is billed on a UB claim form at the OMB rate.
Both the originating and distant sites may be IHS or tribal facilities with two different locations; or a distant site can be under contract to the IHS or tribal facility. If the distant site is an IHS or tribal facility, the distant site may also bill the OMB rate when the service is typically paid at OMB rates.
SOURCE: NM Behavioral Health Policy and Billing Manual for Providers, pg. 30, (Accessed Jun. 2024).
FQHC
A telemedicine communication fee is paid for the originating site at fee schedule rates using the CMS 1500 format; not the encounter rate. The originating clinical service fee is billed on a UB claim form if for evaluation or therapy and on a CMS 1500 if for a special service and reimbursed at the encounter rate.
SOURCE: NM Behavioral Health Policy and Billing Manual for Providers, pg. 30, (Accessed Jun. 2024).
Last updated 06/17/2024
Miscellaneous
MCOs must:
- Promote and employ broad-based utilization of statewide access to Health Insurance Portability and Accountability Act (HIPAA)-compliant telemedicine service systems including, but not limited to, access to text telephones or teletype (TTYs) and 711 telecommunication relay services;
- Follow state guidelines for telemedicine equipment or connectivity;
- Follow accepted HIPAA and 42 CFR part two regulations that affect telemedicine transmission, including but not limited to staff and contract provider training, room setup, security of transmission lines, etc; the MCO shall have and implement policies and procedures that follow all federal and state security and procedure guidelines;
- Identify, develop, and implement training for accepted telemedicine practices;
- Participate in the needs assessment of the organizational, developmental, and programmatic requirements of telemedicine programs;
- Report to HSD on the telemedicine outcomes of telemedicine projects and submit the telemedicine report; and
- Ensure that telemedicine services meet the following shared values, which are ensuring: competent care with regard to culture and language needs; work sites are distributed across the state, including native American sites for both clinical and educational purposes; and coordination of telemedicine and technical functions at either end of network connection.
The MCO shall participate in project extension for community healthcare outcomes (ECHO), in accordance with state prescribed requirements and standards, and shall:
- Work collaboratively with HSD, the university of New Mexico, and providers on project ECHO;
- Identify high needs, high cost members who may benefit from project ECHO participation;
- Identify its PCPs who serve high needs, high cost members to participate in project ECHO;
- Assist project ECHO with engaging its MCO PCPs in project ECHO’s center for Medicare and Medicaid innovation (CMMI) grant project;
- Reimburse primary care clinics for participating in the project ECHO model;
- Reimburse “intensivist” teams;
- Provide claims data to HSD to support the evaluation of project ECHO;
- Appoint a centralized liaison to obtain prior authorization approvals related to project ECHO; and
- Track quality of care and outcome measures related to project ECHO.
SOURCE: NM Administrative Code 8.308.9.18. (Accessed Jun. 2024).
Under 21 U.S.C. § 802(54)(A),(B), for most (DEA-registered) Practitioners in the United States, including Qualifying Practitioners and Qualifying Other Practitioners (“Medication Assisted Treatment Providers”), who are using FDA approved Schedule III-V controlled substances to treat opioid addiction, the term “practice of telemedicine” means the practice of medicine in accordance with applicable Federal and State laws, by a practitioner (other than a pharmacist) who is at a location remote from the patient, and is communicating with the patient, or health care professional who is treating the patient using a telecommunications system referred to in (42 CFR § 410.78(a)(3)) which practice is being conducted in a few unique situations. See manual for more details.
SOURCE: NM Human Services Dept. Behavioral Health Policy and Billing Manual for Providers Treating Medicaid Beneficiaries (2021) p. 28 (Accessed Jun. 2024).
Patient-Centered Initiatives
The New Mexico PCMH will include State-specific goals tailored to the unique needs of communities and patients.
Core components of the New Mexico PCMH Model include:
Clinical:
- Improved access to care through flexible scheduling, accommodating walk-ins, utilization of telemedicine, providing after hours and weekend office hours
SOURCE: NM Centennial-Care Managed Care Policy (2020) pg. 304 (Accessed Jun. 2024).
Referral to Community and Social Support Services
Referrals to community and social support services help overcome access and service barriers, increase self-management skills, and improve overall health. Providers identify available and effective community-based resources and actively link and manage appropriate referrals. Linkages support the personal needs of members and are consistent with the service plan. Community and social support service referral activities may include, but are not limited to:
- Identifying and patterning with community-based and telehealth resources such as medical and behavioral health care, durable medical equipment (DME), legal services, housing, respite, educational and employment supports, financial services, recovery and treatment plan goal supports, entitlements and benefits, social integration and skill building, transportation, personal needs, wellness and health promotion services, specialized support groups, supports for substance use and prevention and treatment, and culturally-specific programs such as veterans’ or IHS and Tribal programs
SOURCE: NM CareLink Health Homes Policy Manual 2021. (Accessed Jun. 2024).
Last updated 06/17/2024
Store and Forward
POLICY
MAD will reimburse for services delivered through store-and-forward. To be eligible for payment under store-and-forward, the service must be provided through the transference of digital images, sounds, or previously recorded video from one location to another; to allow a consulting provider to obtain information, analyze it, and report back to the referring physician providing the telemedicine consultation. Store-and-forward telemedicine includes encounters that do not occur in real time (asynchronous) and are consultants that do not require face-to-face live encounter between patient and telemedicine provider.
SOURCE: NM Administrative Code 8.310.2.12 (M). (Accessed Jun. 2024).
Applied Behavior Analysis
If members of the Family Set cannot face-to-face attend the recipient’s sessions, then other opportunities must be explored, such as the members of the Family Set participating via telemedicine (in real-time or through store-and-forward means).
Store-and-Forward telemedicine does not occur in real time (asynchronous) and does not require a F2F live encounter with the eligible recipient and the Mentored BA/Mentored BA/BAA/RBT/BCAT and the BA/Mentored BA/Supervising BAA. This technology allows through the transference of digital images, sounds, or previously recorded video sent from the onsite practitioner to the BA/Mentored BA/Supervising BAA to obtain information, analyze it, and report back to the onsite practitioner during their T1026 UD Case Supervision.
SOURCE: NM Medicaid Manual, Applied Behavior Analysis Guidance Supplement, pg. 26, 35. (Accessed Jun. 2024).
ELIGIBLE SERVICES/SPECIALTIES
No Reference Found
GEOGRAPHIC LIMITS
No Reference Found
TRANSMISSION FEE
No Reference Found
