New Mexico Telemedicine & Telehealth Reimbursement Overview

Provider Reimbursement Eligibility
Consent for Telemedicine Live Video Reimbursement Store & Forward Reimbursement Originating Site & Transmission Fees Eligible Practitioners
State Law

No Reference Found

New Mexico reimburses for live video as part of telemedicine.

NM Stat § 59A-22-49.3 (2013)

Store and forward is included in the definition of telemedicine.

NM Stat § 59A-22-49.3 (2013)

B. A group health plan shall not impose an originating-site restriction with respect to telemedicine services or distinguish between telemedicine services provided to patients in rural locations and those provided to patients in urban locations; provided that the provisions of this section shall not be construed to require coverage of an otherwise noncovered benefit.

E. Nothing in this section shall require a health care provider to be physically present with a patient at the originating site unless the consulting telemedicine provider deems it necessary.

New Mexico SB 354 Effective June 14, 2019

Provider options are open.  Specific examples are listed in Sec. 3A of HCPA/HB 581

Medicaid

No Reference Found

New Mexico reimburses for live video.

See Pg. 12, Sec. M1 of NM Administrative Code 8.310.2.

Store and forward is reimbursable, but eligibility requirements need to be met.

See Pg. 12, Sec. M3 of NM Administrative Code 8.310.2.

An originating-site is 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 medically warranted site.

TITLE 8 SOCIAL SERVICES CHAPTER 310   HEALTH CARE PROFESSIONAL SERVICES PART 2 – 8.310.2.12 Subsection M

One of 19 States that does not specify the type of healthcare provider allowed to practice telemedicine.

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

See Telemedicine Reimbursement Guide – Medicare Section

See Telemedicine Reimbursement Guide – Medicare Section

See Telemedicine Reimbursement Guide – Medicare Section

See Telemedicine Reimbursement Guide – Medicare Section

Private Payors

Private payors are actively exploring telemedicine and telehealth, but each provider is different. If you are in network with a specific provider, call and request documentation of their policy related to telehealth.

Self Pay

There are no limitations for self pay patients/clients, and providing telehealth services is a great way to increase revenue with patients that are selfpay or value premium services.

Provider Reimbursement Eligibility
Consent for Telemedicine
State Law

No Reference Found

Medicaid

No Reference Found

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Live Video Reimbursement
State Law

New Mexico reimburses for live video as part of telemedicine.

NM Stat § 59A-22-49.3 (2013)

Medicaid

New Mexico reimburses for live video.

See Pg. 12, Sec. M1 of NM Administrative Code 8.310.2.

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Store & Forward Reimbursement
State Law

Store and forward is included in the definition of telemedicine.

NM Stat § 59A-22-49.3 (2013)

Medicaid

Store and forward is reimbursable, but eligibility requirements need to be met.

See Pg. 12, Sec. M3 of NM Administrative Code 8.310.2.

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Originating Site & Transmission Fees
State Law

B. A group health plan shall not impose an originating-site restriction with respect to telemedicine services or distinguish between telemedicine services provided to patients in rural locations and those provided to patients in urban locations; provided that the provisions of this section shall not be construed to require coverage of an otherwise noncovered benefit.

E. Nothing in this section shall require a health care provider to be physically present with a patient at the originating site unless the consulting telemedicine provider deems it necessary.

New Mexico SB 354 Effective June 14, 2019

Medicaid

An originating-site is 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 medically warranted site.

TITLE 8 SOCIAL SERVICES CHAPTER 310   HEALTH CARE PROFESSIONAL SERVICES PART 2 – 8.310.2.12 Subsection M

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Eligible Practitioners
State Law

Provider options are open.  Specific examples are listed in Sec. 3A of HCPA/HB 581

Medicaid

One of 19 States that does not specify the type of healthcare provider allowed to practice telemedicine.

Medicare

See Telemedicine Reimbursement Guide – Medicare Section

Private Payors

Private payors are actively exploring telemedicine and telehealth, but each provider is different. If you are in network with a specific provider, call and request documentation of their policy related to telehealth.

Self Pay

There are no limitations for self pay patients/clients, and providing telehealth services is a great way to increase revenue with patients that are selfpay or value premium services.

Telemedicine CPT Codes

Unique CPT codes do not exist specifically for telemedicine or telehealth. Instead a modifier is applied to existing codes.

  • For interactive audio and video sessions, place a GT modifier in front of the CPT codes you typically use for in person services.
  • For services provided via an asynchronous telecommunication system, simply add a GQ modifier in front of the CPT codes you typically use for in person services.

Telehealth Parity

B. Group health coverage, including any form of self-insurance, offered, issued or renewed under the Health Care Purchasing Act shall provide coverage for services provided via telemedicine to the same extent that the group health plan covers the same services when those services are provided via in-person consultation or contact. A group health plan shall not impose any unique condition for coverage of services provided via telemedicine.

I. A group health plan shall reimburse for health care services delivered via telemedicine on the same basis and at least the same rate that the group health plan reimburses for comparable services delivered via in-person consultation or contact.

New Mexico SB 354 Effective June 14, 2019

Telemedicine 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 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.

TITLE 8 SOCIAL SERVICES CHAPTER 310   HEALTH CARE PROFESSIONAL SERVICES PART 2 – 8.310.2.12 Subsection M

Definitions

Telehealth Parity

Telehealth services are equal to in person services and reimbursed at the same rate.

Asynchronous Communication

The exchange of messages, such as among the hosts on a network or devices in a computer, by reading and responding as schedules permit rather than according to some clock that is synchronized for both the sender and receiver or in real time. Email, chat and text messaging are primary examples of asynchronous communication.

Distant or Hub Site

The location or site where the practitioner or provider is located while utilizing telemedicine services to meet with patients.

Originating Site

The location of the patient at the time services are provided. An originating site can be the client's home or a public facility like a rural hospital or physician's office. Many payors will reimburse for an originating site fee if it meets specific requirements. Rural use cases provide an applicable example for an eligible originating site fee where the patient will go to a local medical facility like a primary care physician's office and meet with a specialist located in distant urban health facility.

Additional Telemedicine Resources

Telehealth and telemedicine are fast growing and changing segments. Both state licensure and state legislation are changing rapidly along with federal legislation and for this reason the information provided cannot be considered legal advice. We make every attempt to keep state specific information up to date, but encourage you to validate this information through the following sites: