Report Type: Funding Infrastructure Medicaid Provider Resource
Fee Schedule for Behavioral Health Providers
YEAR
2023
AUTHOR / ORGANIZATION
NM Health Care Authority
GEOGRAPHIC SCOPE
Statewide (New Mexico)
What is this?
This is an official Medicaid fee schedule published by the New Mexico Human Services Department establishing reimbursement rates for behavioral health services effective January 1, 2025. It serves as the authoritative reference for fee-for-service Medicaid billing by behavioral health providers across the state. The document covers residential treatment centers (youth and adult), crisis triage centers, opioid treatment programs, specialized outpatient services, evidence-based therapies, and standard evaluation and therapy codes. It specifies CPT/HCPCS codes, revenue codes, modifiers, unit definitions, maximum units, and rendering provider requirements for each service category.
Summary
The 2025 Behavioral Health Fee Schedule provides critical infrastructure for understanding the financial framework supporting behavioral health services in New Mexico. For systems change planning in Bernalillo County, this document reveals several key insights: the state has established dedicated rates for evidence-based practices including Trauma-Focused CBT, EMDR, Dialectical Behavioral Therapy, Multisystemic Therapy, and Functional Family Therapy, signaling policy support for these interventions. Crisis services have detailed rate structures including mobile crisis response ($1,804.61 per encounter for licensed response) and stabilization services, supporting the crisis continuum. High-Fidelity Wraparound receives substantial support at $2,336.23 PMPM for youth in multiple systems. The fee schedule includes rural rate modifiers (TN) acknowledging geographic access challenges. Assertive Community Treatment, Intensive Outpatient Programs, and peer support services are all reimbursable, indicating pathways for community-based care expansion. Notably, managed care rates may differ, and BHSD-paid services follow separate schedules. Systems planners can use this information to assess financial sustainability of proposed program expansions, identify adequately-funded versus underfunded service areas, and understand billing requirements that affect provider participation.
BH Systems Change Recommendations
How This Report Informs Systems Change This fee schedule does not contain explicit systems change recommendations but provides essential data for planning: 1. **Service Viability Assessment**: The rates establish baseline financial sustainability for different service types. Systems planners can compare these rates against actual provider costs to identify services at risk of underfunding. 2. **Evidence-Based Practice Incentives**: Enhanced rates for TF-CBT, EMDR, DBT, MST, and FFT indicate state investment in evidence-based practices. Systems planners should ensure adequate provider capacity in these modalities. 3. **Crisis Continuum Support**: Detailed mobile crisis and stabilization rates support development of a comprehensive crisis response system, with specific provisions for children's services (MRSS) and peer involvement. 4. **Youth System Investment**: Substantial rates for High-Fidelity Wraparound, Treatment Foster Care, and youth-specific residential services indicate state commitment to keeping youth in less restrictive settings. 5. **Workforce Considerations**: Different rates for master's-level, bachelor's-level, and peer providers allow systems to model workforce mix and associated costs. 6. **Rural Access**: The TN modifier providing approximately 20% rate increase for rural services acknowledges geographic disparities that Bernalillo County systems must consider for regional coordination. 7. **Managed Care Negotiations**: Since MCO rates are negotiated separately, systems planners should track whether MCO rates align with fee-for-service rates to ensure consistent service availability across payer types.
How to Use for Systems Planning
What this report IS useful for: - Calculating projected costs for new program development or service expansion - Understanding which services are reimbursable under Medicaid and at what rates - Identifying provider requirements for different service types - Comparing relative state investment across service categories - Planning workforce composition based on rate differentials by credential level - Understanding billing requirements that affect provider administrative burden - Assessing financial viability of evidence-based practice implementation What this report DOES NOT provide: - Actual service utilization data or capacity information - Managed care organization negotiated rates (which may differ significantly) - Quality metrics or outcomes expectations for services - Provider network adequacy information - Gap analysis between current and needed service capacity - Rates for Behavioral Health Services Division-paid services (separate schedule) - Applied Behavior Analysis for Autism rates (separate fee schedule) - Comparison to provider costs or market rates
Key Facts & Data Points
- Effective date: January 1, 2025 - Youth Residential Treatment Center daily rate: $470.58 - Adult SUD Residential Tier 3 (ASAM 3.7/3.7WM): $607.98/day - Mobile Crisis Licensed Response: $1,804.61 per encounter - Mobile Crisis with Peer: $1,814.13 per encounter - High-Fidelity Wraparound: $2,336.23 PMPM - Assertive Community Treatment (ACT): $79.50 per 15 minutes (face-to-face) - Intensive Outpatient Program (IOP) daily rate: $315.88 - Youth IOP daily rate: $236.91 - Partial Hospitalization: $793.57/day (minimum 4 hours of services) - Treatment Foster Care Level I: $491.19/day - Treatment Foster Care Level II: $364.88/day - Methadone clinic services: $21.11/day - Individual Peer Support: $25.06 per 15 minutes - Group Peer Support: $11.43 per 15 minutes - Comprehensive Multidisciplinary Team Evaluation (SMI/SED): $641.11 - Psychiatric Diagnostic Evaluation: $249.22 - TF-CBT enhanced rates range from $119.97 (30 min) to $239.94 (60 min) - EMDR enhanced rates range from $121.17 (30 min) to $242.35 (60 min) - DBT Therapist rate: $112.89 per 15 minutes - Rural modifier (TN) increases rates approximately 20-23%
Priority Services & Findings
**SUD Organizations** - Adult SUD Residential Tier 1 (ASAM 3.1): $249.04/day - Adult SUD Residential Tier 2 (ASAM 3.2WM, 3.2, 3.3, 3.5): $349.76/day - Adult SUD Residential Tier 3 (ASAM 3.7, 3.7WM): $607.98/day - Opioid Treatment Program initial medical exam: $80.18 - Methadone clinic daily services: $21.11 - OTP counseling individual: $63.56 per 30 minutes - OTP group counseling: $50.79 per 30 minutes - Suboxone oral medication administration/direct observation: $476.14 - ASAM Level of Care Assessment: $197.10 - IOP for SUD: $315.88/day (youth: $236.91/day) - Withdrawal management codes for tracking (no separate payment) **Mental Health / Crisis Care** - Mobile Crisis Licensed Response: $1,804.61/encounter - Mobile Crisis with Peer: $1,814.13/encounter - Mobile Crisis Non-Licensed Response: $1,586.78/encounter - Mobile Crisis with Telehealth: $1,084.96/encounter - Crisis Intervention 15-minute rates: $26.88 (telephone), $40.06 (face-to-face), $80.14 (2-person mobile), $40.06 (stabilization) - Crisis Triage Center rates: based on cost analysis - Stabilization Services for Children: $48.53-$90.73 per 15 minutes - Mobile Crisis Follow-Up Telephone: $27.75 per 15 minutes - Psychotherapy Crisis: $212.35 (first 60 min), $105.35 (additional 30 min) - Partial Hospitalization: $793.57/day - ACT: $79.50 per 15 minutes (face-to-face) - IMD rates for mental disease: percentage of billed charges, cost settled **Integrated Primary Care** - FQHC BH services: FQHC encounter rate - IHS/Tribal BH services: OMB rate or negotiated - SBIRT Screening: $42.85 - SBIRT Brief Intervention: $85.70 per 15 minutes - Other Behavioral Health Screening (G0444): $26.36 - Other Brief Intervention: $35.87 per 15 minutes - Nursing Assessment/Evaluation: $69.19 per event (up to 16 units if prolonged) - Comprehensive Medication Services: $47.62 per 15 minutes - E&M codes reference CPT fee schedule **School-Based / Youth Services** - Youth RTC: $470.58/day - ARTC Psychiatric for youth: $677.80/day - ARTC Chemical Dependency for youth: $677.80/day - Group Home for youth: $290.49/day - High-Fidelity Wraparound: $2,336.23 PMPM - Treatment Foster Care Level I: $491.19/day - Treatment Foster Care Level II: $364.88/day - Youth IOP (MH and SUD): $236.91/day - MRSS team modifier (HA) for children's crisis services - Multisystemic Therapy: $55.54-$87.20 per 15 minutes (existing teams), $60.18-$98.10 (new teams) - Functional Family Therapy: $60.30-$81.37 per 15 minutes (existing teams), $74.22-$98.10 (new teams) - Trauma-Focused CBT: $119.97-$239.94 per session - Behavioral Health Day Treatment: $27.78/hour - Behavior Management Skills Training: $14.48 per 15 minutes
Immediate Actions for Systems Planners
-Cross-reference this fee schedule with current provider network data to identify services with adequate vs. inadequate reimbursement relative to provider costs in Bernalillo County. -Convene conversations with local managed care organizations to compare their negotiated behavioral health rates with this fee-for-service schedule to identify potential disparities affecting service availability. -Review the enhanced rates for evidence-based practices (TF-CBT, EMDR, DBT, MST, FFT) and assess current provider capacity to deliver these services in Bernalillo County. -Evaluate the mobile crisis and stabilization service rate structure against current and planned crisis response system costs to ensure financial sustainability. -Analyze the High-Fidelity Wraparound rate ($2,336.23 PMPM) against program implementation costs to assess viability for expanding youth intensive services. -Map the peer support reimbursement rates ($25.06 individual, $11.43 group per 15 minutes) against workforce development plans to ensure peer specialist positions are financially sustainable. -Assess SUD residential treatment rate tiers against current capacity and demand to identify potential service gaps at each ASAM level. -Distribute this fee schedule to behavioral health provider partners for awareness and feedback on rate adequacy.
Key Contacts
**/ - NM Human Services Dept (HSD) **/ - Behavioral Health Services Division (BHSD)