Last updated 11/18/2024
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 Nov. 2024).
Medication Assisted Treatment Services in Correctional Settings
Telemedicine: The delivery of health care services through interactive audio, video, or other electronic media used for diagnosis, consultation, or treatment.
SOURCE: NM Administrative Code 8.321.12.7. (Accessed Nov. 2024).
Last updated 11/18/2024
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 Nov. 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 Nov. 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 Nov. 2024).
Mobile Crisis Intervention
Mobile crisis intervention services include telephonic follow-up for up to 72 hours after the initial mobile response, which may include, where appropriate, additional intervention and de-escalation services and coordination with and referrals to health, social, emergency services, and other services and supports, as needed.
See supplement for codes for mobile crisis providers.
Crisis providers cannot bill a mobile crisis unit code (H2011), mobile crisis per diem (S9485) and/or MRSS stabilization (S9482) rate on the same day. Crisis providers cannot bill a mobile crisis per diem (S9485) and a telephonic follow-up call (H0030) in the same day.
Authorization for Telephonic Follow-up (H0030) is not required if it follows a mobile crisis intervention service.
SOURCE: NM Medical Assistance Program Supplement, Mobile Crisis Providers, Number 24-14, Oct. 7, 2024, (Accessed Nov. 2024).
Last updated 11/18/2024
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 Nov. 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 Nov. 2024).
Telemedicine is also covered by NM Managed Care.
SOURCE: NM Medical Assistance Division Managed Care Policy Manual, p. 323. Oct. 1, 2020. (Accessed Nov. 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 Nov. 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 Nov. 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 Nov. 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 Nov. 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 Nov. 2024).
The alternative benefits package includes telemedicine services.
SOURCE: NM Centennial Care Managed Care Policy Manual, Oct. 1. 2020, (Accessed Nov. 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 Nov. 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 Nov. 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 Nov. 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 Nov. 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 Nov. 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 Nov. 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 Nov. 2024).
Mobile Crisis Providers
MCT/MRSS Staffing Requirements – Mobile crisis intervention services are furnished by a multidisciplinary team that includes at least two members. The team includes at least one behavioral health care professional able to conduct a clinical assessment within their permitted scope of practice under state law and who may be available via telehealth.
See supplement for codes for mobile crisis providers.
SOURCE: NM Medical Assistance Program Supplement, Mobile Crisis Providers, Number 24-14, Oct. 7, 2024, (Accessed Nov. 2024).
Crisis Triage Centers – Staffing Requirements
Minimum staffing requirements:…
- The CTC shall have an RN present on-site 24 hours a day, seven days a week or as long as clients are present in programs that do not offer residential services, to provide direct nursing services. This requirement does not apply to CTCs offering 23 hours or less non-residential services; instead these CTCs may have onsite medical professionals who have access to immediate support and supervision by an RN or a higher-level provider in accordance with Section 24-25-1 et al. NMSA 1978 New Mexico Telehealth Act.
- An on-call physician or advanced practice registered nurse shall be available 24 hours a day by phone, and available on-site as needed or through telehealth.
- Consultation by a psychiatrist or prescribing psychologist may be provided through telehealth.
SOURCE: NM Administrative Code 8.321.11.29. (Accessed Nov. 2024).
Medication Assisted Treatment Services in Correctional Settings
Facility contracts with medical service provider (to include onsite or telemedicine resources).
SOURCE: NM Administrative Code 8.321.12.9. (Accessed Nov. 2024).
Staffing Requirements – Correctional Facilities
Correctional facilities shall:
- Develop adequate staffing patterns including healthcare practitioners authorized by law to prescribe, administer, and monitor medication-assisted treatment (to include telehealth-supported clinical review or services if necessary).
SOURCE: NM Administrative Code 8.325.12.11. (Accessed Nov. 2024).
ABA Services
Training and participation by members of the Family Set are also seen as important components. Every Treatment Plan must include ample units of ABA Stage 3 97156 and 97157. For a member of the Family Set who is unable to participate in every ABA Stage 3 session, the BA/Mentored BA is required to provide alternative methods such as the use of telemedicine to encourage the participation of the recipient’s Family Set members.
The ABA Treatment Plan must identify all target behaviors that are to be addressed by the ABA Stage 3 practitioners. The following elements are required in the treatment plan: …
- Be recipient-centered, Family Set-focused, and minimally intrusive, with a focus on family engagement, training, and support; 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)
See supplement for additional details.
SOURCE: NM Medical Assistance Program Supplement, Applied Behavior Analysis (ABA) Guidance, Number 24-13, Sept. 17, 2024, (Accessed Nov. 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 Nov. 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 Nov. 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 Nov. 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 Nov. 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 Nov. 2024).
ABA Services Delivered via Telehealth
New Mexico does not require an in-state AEP/Qualifying Psychologist/BCBA-D/BCBA/BCaBA/RBT/BCAT/noncertified BT to have a telemedicine license. However, if the AEP is an out of state MD/DO, the New Mexico Medical Board does require this practitioner to obtain a telemedicine license (or a full NM medical license).
The BICC, BACB, and New Mexico Regulation and Licensing Department (RLD) psychologist’s practice board allows and supports the use of telehealth to deliver ABA services. MAD allows and encourages the utilization of telemedicine to deliver MAD ABA services to assist AEPs and AP agencies provide cost effective and home and community-based services to rural and frontier areas of New Mexico.
SOURCE: NM Medical Assistance Program Supplement, Applied Behavior Analysis (ABA) Guidance, Number 24-13, Sept. 17, 2024, (Accessed Nov. 2024).
Mobile Crisis Providers
Telehealth is allowable, however in vivo MCT and MRSS response is preferred. MCT and MRSS providers can use telehealth to ensure rapid response and clinical decision-making to ensure the crisis is resolved safely.
SOURCE: NM Medical Assistance Program Supplement, Mobile Crisis Providers, Number 24-14, Oct. 7, 2024, (Accessed Nov. 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 Nov. 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 Nov. 2024).
School-based services provided via telemedicine are covered.
SOURCE: NM Administrative Code 8.320.6.13(I). (Accessed Nov. 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 Nov. 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 Nov. 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 Nov. 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 Nov. 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 Nov. 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 Nov. 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 Nov. 2024).
Last updated 11/18/2024
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 Nov. 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 Nov. 2024).
ABA Services
To increase rural and frontier ABA Stage 3 services, MAD allows Store-and-Forward telemedicine technology transmissions for ABA Stage 3 97155. 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 Medical Assistance Program Supplement, Applied Behavior Analysis (ABA) Guidance, Number 24-13, Sept. 17, 2024, (Accessed Nov. 2024).
ELIGIBLE SERVICES/SPECIALTIES
ABA Services
MAD allows an AP agency to utilize Store-and-Forward telemedicine technology to provide 100% of Direct 97155 to be rendered when the following requirements are met:
- An AP agency must submit on an annual basis to the MCO or TPA documentation from the AP agency’s telemedicine transmission provider cannot provide real-time telemedicine transmissions between the recipient’s location and the BA’s/Mentored BA’s/Supervising BAA’s location. This must also be documented in the recipient’s clinical file.
- 97155 must be increased at least by two 15-minute units or 30 minutes and up to four 15-minute units or 1 hour in addition to the required minimum two 15-minute units or 30 minutes. This would allow the BA/Mentored BA/Supervising BAA to have additional time to discuss and plan with the BAA/RBT/BCAT the implementation of the ABA Treatment Plan and Treatment Protocols.
- The BA/Mentored BA/Supervising BAA must document in the recipient’s file that the use to 97155 delivered through Store-and-Forward telemedicine technology meets the needs of the family, recipient and BAA’s/RBT’s/BCAT’s personnel file substantiates the he or she has the expertise to receive 100% 97155 delivered through Store-and-Forward telemedicine technology, and without the use of Store-and-Forward telemedicine technology the recipient could not access ABA Stage 3 services.
- A non-certified BT cannot receive 97155f delivered through Store-and-Forward telemedicine technology.
SOURCE: NM Medical Assistance Program Supplement, Applied Behavior Analysis (ABA) Guidance, Number 24-13, Sept. 17, 2024, (Accessed Nov. 2024).
GEOGRAPHIC LIMITS
No Reference Found
TRANSMISSION FEE
No Reference Found
