New Mexico Medicaid ABA Reimbursement Rates (2026)
From official New Mexico Medicaid sources. Updated July 2026.
These are the published New Mexico Medicaid rates for applied behavior analysis (ABA) services. Rates are shown as published. For per-15-minute rows, multiply by 4 for the hourly rate; rows priced per hour, per session, or per assessment are labeled in the table.
New Mexico ABA Fee Schedule
| Code | Service | Rate | Unit | Effective | Source |
|---|---|---|---|---|---|
| 97151 (U3) | Behavior identification assessment (U3 — BCBA) BCBA rate (U3 modifier). BCBA-D/Psych = $130.94. | $112.65 | per 15 min | 2025-01-01 | source |
| 97153 (U1) | Adaptive behavior treatment by protocol (U1 — Behavior Technician) BT/technician rate (U1). BCaBA=$23.35, BCBA=$32.31, BCBA-D=$37.99, Psych=$38.02. | $19.85 | per 15 min | 2025-01-01 | source |
| 97153 (U3) | Adaptive behavior treatment by protocol (U3 — BCBA) BCBA rate (U3 modifier) | $32.31 | per 15 min | 2025-01-01 | source |
| 97155 (U3) | Adaptive behavior treatment w/ protocol modification (U3 — BCBA) BCBA rate (U3). BCBA-D/Psych = $55.55. | $39.69 | per 15 min | 2025-01-01 | source |
How New Mexico Compares
| Code | New Mexico | National median | Difference |
|---|---|---|---|
| 97151 (U3) | $112.65 | $29.14 | 287% above national median |
| 97153 (U1) | $19.85 | $15.00 | 32% above national median |
| 97155 (U3) | $39.69 | $24.18 | 64% above national median |
Market Context
New Mexico has had an autism insurance mandate since 2009. About 310,526 children in New Mexico are enrolled in Medicaid. Autism prevalence is 2.8% (2022 data). ProviderSpark lists 51 verified ABA provider locations in New Mexico.
Getting Paneled with Turquoise Care
New Mexico’s Medicaid managed care program is called Turquoise Care, renamed from Centennial Care 2.0 on July 1, 2024, and administered by the NM Health Care Authority (HCA), Medical Assistance Division (MAD). Since August 1, 2024, every provider enrollment runs through the online portal — paper forms are gone, and online applications process about 3 weeks faster.
- Enroll as a New Mexico Medicaid provider through the Provider Web Portal.
- Pass the New Mexico criminal background registry check — required for every ABA credential level, from AEP down to non-certified behavior technician.
- Submit the credential-specific ABA attestation form from HCA’s ABA provider page — MAD-877 for BCBA/BCBA-D, MAD-873 for BCaBA, MAD-878 for RBT/BCAT, MAD-880 for non-certified BTs.
- Get separately credentialed with each Turquoise Care MCO you plan to bill — an AEP or BA must be MCO-credentialed before rendering Stage 1 services to that plan’s members.
- For fee-for-service clients, route Stage 3 (97153) and Specialty Care (0373T) prior-authorization requests through MAD’s Third-Party Assessor.
How New Mexico Delivers ABA
New Mexico runs a hybrid model — both fee-for-service and managed care. Four Turquoise Care MCOs cover ABA: Blue Cross Blue Shield of New Mexico, Molina Healthcare of New Mexico, Presbyterian Health Plan, and United Healthcare Community Plan of New Mexico. What that means for your rate: HCA Letter of Direction #53 (retroactive to 1/1/2025) bars every one of those MCOs from paying less than the Medicaid fee-for-service rate for ABA codes. That sets a statewide floor — a BCBA-rendered 97151 assessment pays $112.65 per 15-minute unit, and AEP evaluation/ISP codes (T1026) pay $206.33 per hour, no matter which MCO you’re billing.
Billing Notes
Most ABA codes don’t need prior authorization. Stage 1 (CDE, Targeted/Risk Evaluation, ISP, ISP update, all billed under T1026) is PA-free, as are the Stage 2 assessment codes (97151/97152/0362T). Within Stage 3, only 97153 (the core direct-treatment code) and 0373T (Specialty Care protocol modification) require PA, renewed every 6 months; the rest of Stage 3, including T1026 clinical management and case supervision, is PA-free. One threshold to watch: T1026 clinical management and case supervision must run at least 1 hour per 10 hours of Stage 3 services, and going over 2 hours per 10 hours triggers its own PA requirement.
Telehealth is reimbursable statewide, and MAD “allows and encourages” it to reach rural and frontier areas — no New Mexico telemedicine license is needed (only an out-of-state MD/DO AEP needs one).
Watch the billing quirk on T1026: it’s a 60-minute code billed in fractional units based on actual minutes, not standard 15-minute rounding. 8–22 minutes bills at 25% of the full-unit rate, 23–37 minutes at 50%, 38–52 minutes at 75%, and 53–67 minutes at 100%. Get that wrong on the claim form and it gets rejected or underpaid.
Common Questions
What does New Mexico Medicaid pay for CPT 97153?
See the rate table above for the codes New Mexico publishes.
What are the main ABA CPT codes?
97151 is the assessment. 97153 is direct treatment by a technician. 97155 is treatment with protocol modification by the BCBA. 97156 is family guidance.
Are these New Mexico rates current?
Rates come from the state fee schedule and were last checked July 2026. Each row links to its source. Always confirm against the current fee schedule before billing.
Compare neighboring states: Texas · Arizona · Colorado · Oklahoma